替罗非班冠状动脉与静脉给药对行经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者微血管阻塞的影响  

Effects of Coronary Arterial and Intravenous Administration of Tirofiban on Microvascular Occlusion in Patients with ST-Elevated Myocardial Infarction Undergoing Percutaneous Coronary Intervention

作　　者：单红英 杨学东[2] 徐勇[2] 王至军 林剑 王禹 SHAN Hongying;YANG Xuedong;XU Yong;WANG Zhijun;LIN Jian;WANG Yu(Dept.of Physical Examination Center,Qinhuangdao Zhuozhong Hospital,Hebei Qinhuangdao 066000,China;Dept.of Cardiology,General Hospital of PLA,Beijing 100853,China;Dept.of Cardiology,Affiliated Hospital of North China University of Science and Technology,Hebei Tangshan 063000,China;Dept.of Cardiology,the First Hospital of Qinhuangdao City,Hebei Qinhuangdao 066001,China;Dept.of Cardiology,Qinhuangdao Zhuozhong Hospital,Hebei Qinhuangdao 066000,China)

机构地区：[1]秦皇岛卓众医院体检中心,河北秦皇岛066000 [2]解放军总医院心内科,北京100853 [3]华北理工大学附属医院心内科,河北唐山063000 [4]秦皇岛市第一医院心内科,河北秦皇岛066001 [5]秦皇岛卓众医院心内科,河北秦皇岛066000

出　　处：《中国医院用药评价与分析》2021年第5期543-547,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：河北省卫生计生委医学科学研究重点课题(No.20171652)。

摘　　要：目的:通过与静脉内注射比较,探讨冠状动脉内注射替罗非班对行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的ST段抬高型心肌梗死(ST-elevated myocardial infarction,STEMI)患者微血管阻塞的影响。方法:选取2017年12月至2019年11月秦皇岛市第一人民医院收治的行PCI术的STEMI患者378例,采用随机数字表法将患者分为静脉给药组与冠状动脉给药组,每组189例。冠状动脉给药组患者在术后经抽吸导管于冠状动脉内注射替罗非班,剂量为10μg/kg;然后以0.15μg/(kg·min)的维持剂量持续静脉给药24~48 h。静脉给药组患者首先静脉注射替罗非班,剂量10μg/kg;然后以0.15μg/(kg·min)的维持剂量持续静脉给药24~48 h。收集并比较两组患者的基线临床指标,治疗前和治疗6个月后两组患者的经心脏磁共振情况;比较治疗1年后两组患者主要不良心血管事件(major adverse cardiac events,MACE)发生率。采用多变量Logistics回归分析评价患者发生MACE的相关因素。结果:PCI术后,与静脉给药组比较,冠状动脉给药组患者左心室射血分数(LVEF)显著提高(t=3.351,P=0.001),微血管阻塞(MVO)发生率显著降低(χ^(2)=15.377,P<0.001);随访1年时,冠状动脉给药组患者左心室舒张末期容积指数(t=4.591,P<0.001)、左心室收缩末期容积指数(t=8.622,P<0.001)及梗死面积(t=10.664,P<0.001)显著降低,LVEF显著升高(t=4.366,P<0.001),上述差异均有统计学意义。冠状动脉注射替罗非班是STEMI患者PCI术后1年发生MACE的独立保护因素(OR=0.423,95%CI=0.190~0.943,P=0.036)。结论:与静脉注射替罗非班相比,冠状动脉内注射替罗非班可显著改善STEMI患者PCI术后6个月内MVO发生率和左心室重构,降低术后1年MACE发生率。OBJECTIVE:Compared with intravenous injection,to probe into the effect of coronary arterial injection of tirofiban on microvascular occlusion in patients with ST-elevated myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI).METHODS:Totally 378 STEMI patients undergoing PCI admitted into the First Hospital of Qinhuangdao City from Dec.2017 to Nov.2019 were selected and divided into intravenous administration group and coronary arterial administration group via random number table,with 189 cases in each group.The coronary arterial administration group was given tirofiban through suction tube after surgery,with a dosage of 10μg/kg,followed by continuous intravenous administration at a maintenance dose of 0.15μg/(kg·min)for 24-48 h.The intravenous administration group was first received intravenous tirofiban at a dose of 10μg/kg,followed by continuous intravenous administration at a maintenance dose of 0.15μg/(kg·min)for 24-48 h.The baseline clinical indicators,cardiac magnetic resonance before treatment and at 6 months after treatment were collected and compared between two groups;the incidence of major adverse cardiac events(MACE)was compared between two groups after 1 year of treatment.Multivariate logistic regression analysis was used to evaluate the factors associated with the occurrence of MACE.RESULTS:After PCI,compared with intravenous administration group,the left ventricular ejection fraction(LVEF)of patients in the coronary arterial administration group was significantly increased(t=3.351,P=0.001),and the incidence of microvascular occlusion was significantly decreased(χ^(2)=15.377,P<0.001);after 1-year follow-up,the left ventricular end-diastolic volume index(t=4.591,P<0.001),left ventricular end-systolic volume index(t=8.622,P<0.001)and infarct size(t=10.664,P<0.001)of patients in the coronary arterial administration group were significantly decreased,and the LVEF was significantly increased(t=4.366,P<0.001),with statistically significant differences.Coronary artery injec

关 键 词：替罗非班 ST段抬高型心肌梗死 经皮冠状动脉介入治疗 微血管阻塞 

分 类 号：R972[医药卫生—药品]