冠状动脉内注射替罗非班与静脉注射替罗非班对急诊PCI患者疾病转归的比较研究  

Comparison in influence of intracoronary injection or intravenous injection of tirofiban on outcomes in patients undergone emergency PCI

作　　者：刘惠良[1] 王学超[1] 王立立[1] 杜荣品[1] 吴海波[1] 刘佳 李如意[1] Liu Huiliang;Wang Xuechao;Wang Lili;Du Rongpin;Wu Haibo;Liu Jia;Li Ruyi(Center of Cardiology,People's Hospital of Hebei Province,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院心脏中心

出　　处：《中国循证心血管医学杂志》2019年第9期1085-1088,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省科委课题(16277780D)

摘　　要：目的比较冠状动脉(冠脉)内注射替罗非班与静脉注射替罗非班这两种给药方式对急诊经皮冠状动脉介入治疗(PCI)患者疾病转归影响的差异,探讨更好的给药方式。方法收集2015年11月至2017年7月就诊于河北省人民医院时发病时间6~12 h行急诊PCI患者63例,随机分为冠脉内注射组和静脉注射组,给予替罗非班治疗。观察两组术中TIMI血流及心肌灌注TMP分级及住院期间主要不良心血管事件、心功能变化;比较治疗前后血液流变学指标包括血液黏度、全血高切黏度、低切黏度及纤维蛋白原的浓度变化;检测患者血清心肌肌钙蛋白I(cTnI)以及肌酸激酶同工酶(CK-MB)的表达水平。结果冠脉内注射组的心肌血流恢复及心肌灌注优于静脉注射组,同时两组住院期间主要不良心血管事件发生率无明显差异。两组患者治疗后血液流变学指标血液黏度、全血低切黏度及纤维蛋白原的浓度均降低(P<0.05);冠脉内注射组血液流变学各指标降低的绝对值大于静脉注射组,两组比较有统计学意义(P<0.05)。冠脉内注射组患者治疗后的CK-MB、cTnI峰值分别为234.24±119.32(pg/ml)、78.95±26.69(U/L),明显低于静脉注射组患者,两者比较存在显著差异(P<0.05)。结论对急诊PCI患者而言,冠脉内注射替罗非班在改善急诊PCI患者预后发挥的作用优于静脉注射替罗非班。Objective To compare the difference in the influence of intracoronary injection or intravenous injection of tirofiban on outcomes in patients undergone emergency PCI,and to discuss a better mode of drug administration.Methods The patients(n=63)undergone emergency PCI with 6 h to 12 h after disease attack were chosen from People’s Hospital of Hebei Province from Nov.2015 to July 2017.All patients were randomly divided into intracoronary injection group and intravenous injection group,and 2 groups were treated with tirofiban.The grading changes of TIMI blood flow and TIMI myocardial perfusion(TMP),major adverse cardiovascular events(MACE)and heart function during hospitalization were observed in 2 groups during PCI.The changes of hemorrheologic indexes,including blood viscosity,whole blood reduced viscosity at high/low share rate and fibrinogen(FIB)level,were compared before and after treatment.The expressions of cardiac troponin I(cTnI)and creatine kinase-MB isoenzyme(CK-MB)were detected in 2 groups.Results The recovery of TIMI blood flow and TMP were significantly superior in intracoronary injection group to those in intravenous injection group.The incidence of MACE had no significant difference during hospitalization.After treatment,the hemorrheologic indexes,including blood viscosity,whole blood reduced viscosity at high/low share rate and FIB level all decreased in 2 groups(P<0.05).The absolute value of decreases hemorrheologic indexes was higher in intracoronary injection group than those in intravenous injection group with statistical significance(P<0.05).The peak value of CK-MB was(234.24±119.32)pg/ml and that of cTnI was(78.95±26.69)U/L in intracoronary injection group,which were significantly lower than those in intravenous injection group(P<0.05).Conclusion For patients undergone emergency PCI,intracoronary injection of tirofiban has higher efficacy in improving outcomes than intravenous injection of tirofiban.

关 键 词：替罗非班 经皮冠状动脉介入治疗 冠状动脉内注射 静脉注射 

分 类 号：R816.2[医药卫生—放射医学]