半剂量替罗非班联合替格瑞洛用于急性ST段抬高型心肌梗死急诊冠状动脉介入术治疗患者的临床疗效及安全性观察  

Clinical efficacy and safety of half-dose Tirofiban combined with Ticagrelor in emergency coronary intervention for STEMI

作　　者：阿吉木·吾布力哈斯木 阿布力孜·阿卜杜扎依尔 齐曼古丽·亚逊 AJIMU·Wubulihasimu;ABULIZI·Apuduzhayier;QIMANGULI·Yaxun(Department of Coronary Heart Disease,First People's Hospital,Kashi,Xinjiang Uygur Autonomous Region,844000;Pharmaceutical Department of the First People's Hospital of the Kashi District,Kashi City,Xinjiang Uygur Autonomous Region,844000;The heart intensive care unit of the first people's hospital in the Kashi area,Kashi City,Xinjiang Uygur Autonomous Region,844000)

机构地区：[1]喀什地区第一人民医院冠心病一科,新疆维吾尔自治区喀什市,844000 [2]喀什地区第一人民医院药学部,新疆维吾尔自治区喀什市,844000 [3]喀什地区第一人民医院心脏重症监护病房,新疆维吾尔自治区喀什市,844000

出　　处：《中国心血管病研究》2019年第10期899-903,共5页Chinese Journal of Cardiovascular Research

基　　金：新疆维吾尔自治区自然科学基金项目(2017D01C171).

摘　　要：目的探讨半剂量替罗非班联合替格瑞洛用于急性ST段抬高型心肌梗死(STEMI)急诊冠状动脉介入术治疗患者的临床疗效及安全性.方法选取2017年5月至2018年9月在喀什地区第一人民医院行急诊经皮冠状动脉介入治疗(PCI)的STEMI患者180例为研究对象.按随机数字表法分为A组、B组和C组,各60例患者.A组PCI术前、术后常规给予阿司匹林联合氯吡格雷及肝素等,术中冠状动脉内注射替罗非班;B、C组替换A组中氯吡格雷为替格瑞洛,再分别以微量泵按0.1μg·kg^-1·min^-1和0.05μg·kg^-1·min^-1持续静脉泵注替罗非班至术后36h.对比三组临床疗效、心肌损伤指标水平、用药安全性及主要心血管不良事件事件(MACE).结果B、C组临床疗效评价各指标包括术后即刻冠状动脉血流、心肌微循环灌注、ST段抬高回落情况及血小板聚集率均明显优于A组(P<0.05).治疗后,A、B、C三组的cTnI水平分别为(3.19±0.67)ng/ml、(1.86±0.13)ng/ml和(1.73±0.48)ng/ml,CK-MB水平分别为(81.12±5.19)U/L、(68.22±5.61)U/L和(62.28±7.34)U/L,三组治疗后的上述两指标水平均较治疗前下降(P<0.05),且B、C组较A组降低更为显著(P<0.05).B、C组的出血情况总发生率分别为13.33%、3.33%,均明显低于A组的25.00%(P<0.05),其中C组低于B组(P<0.05).随访期间,B、C组的MACE总发生率分别为5.00%和3.33%,均明显低于A组的16.67%(P<0.05).结论替罗非班联合替格瑞洛用于STEMI急诊冠状动脉介入术治疗患者的临床疗效较好,使用半剂量替罗非班能减少出血风险.Objective: To analyze the clinical efficacy and safety of half-dose tirofiban combined with tiglillo in the treatment of STEMI emergency coronary intervention. Methods: 180 STEMI patients who underwent emergency PCI in the First People's Hospital of Kashgar from May 2017 to September 2018 were selected as the study subjects. According to the random number table, the patients were divided into group A, group B and group C, with 60 patients in each group. In group A, aspirin, clopidogrel and heparin were routinely administered before and after PCI, and tirofiban was injected intracoronary;in group B and C, clopidogrel was replaced by tigrilol in group A, and then tirofiban was continuously infused intravenously with micro-pump at 0.1 ug/(kg min) and 0.05 ug/(kg min) until 36 hours after PCI, respectively. The clinical efficacy, myocardial injury index, medication safety and major adverse cardiovascular events (MACE) were compared among the three groups. Results: The clinical evaluation indexes of group B and C, including immediate coronary blood flow, myocardial microcirculation perfusion, ST segment elevation and platelet aggregation, were significantly better than those of group A (P < 0.05). After treatment, the levels of cTnI in group A, B and C were (3.19 ± 0.67) ng/ml,(1.86±0.13) ng/ml and (1.73±0.48) ng/ml respectively, and the levels of CK-MB were (81.12±5.19) U/L,(68.22±5.61) U/L and (62.28±7.34) U/L respectively. After treatment, the levels of the above two indicators in group A, B and C decreased more significantly than those in group A (P < 0.05). The total incidence of bleeding in group B and C was 13.33% and 3.33% respectively, which was significantly lower than that in group A (25.00%, P < 0.05), and that in group C was lower than that in group B (P < 0.05). During the follow-up period, the total incidence of MACE in group B and C was 5.00% and 5.00% respectively, which was significantly lower than that in group A (16.67%)(P < 0.05). Conclusion: Tirofiban combined with tiglillo is effective in

关 键 词：半剂量 替格瑞洛 替罗非班 疗效 安全性 

分 类 号：R542.22[医药卫生—心血管疾病]