急诊PCI的老年STEMI患者冠状动脉内联合静脉注射低剂量替罗非班的临床研究  

Effect of intracoronary and intravenous tirofiban at a low dose for elderly patients with STEMI undergoing emergency PCI

作　　者：李彪[1] 何芸[1] 曾芳[1] 陈希伟 陈耀贵 罗景云[1] 黄伟光[1] 赵强 Li Biao;He Yun;Zeng Fang;Chen Xiwei;Chen Yaogui;Luo Jingyun;Huang Weiguang;Zhao Qiang(Department of Cardiology,Guangzhou Red Cross Hospital,Jinan University,Guangzhou 510220,China;Department of Cardiology,Shunde Hospital,Guangzhou Medical University,Foshan 528315,China)

机构地区：[1]广州市红十字会医院,暨南大学医学院附属广州市红十字会医院心内科,510220 [2]广州医科大学附属顺德医院心内科,广东528315

出　　处：《国际医药卫生导报》2021年第13期1988-1991,共4页International Medicine and Health Guidance News

摘　　要：目的探讨老年急性ST段抬高型心肌梗死(ST elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后冠状动脉内联合静脉注射低剂量替罗非班治疗的疗效性和安全性。方法选取2016年1月至2019年2月广州市红十字会医院收治的108例行PCI的STEMI患者,男性69例,女性39例,年龄(73.68±3.51)岁。采用随机数字表法分为对照组、研究组,各54例。所有患者在冠状动脉恢复血流后立即按10.000μg/kg替罗非班冠状动脉内注射,对照组以0.150μg/(kg·min)、研究组以0.075μg/(kg·min)的速度维持静脉输注24 h后停药。术后观察两组患者ST段完全回落比例、高敏肌钙蛋白T峰值水平、梗死相关动脉血栓评分、PCI后心肌梗死溶栓(TIMI)血流、出血事件,PCI术后90 d左室射血分数和复合主要心脏不良事件。结果对照组与研究组患者的临床特征比较,差异均无统计学意义(均P>0.05)。对照组、研究组患者的ST段完全回落比例[87.04%(47/54)比88.89%(48/54)]、高敏肌钙蛋白T峰值水平[(4.80±1.80)μg/L比(5.20±2.30)μg/L]、梗死相关动脉血栓评分[(0.90±0.55)分比(1.08±0.59)分]、PCI后TIMI 3级血流(48例比49例)、PCI术后90 d左心室射血分数[(50.34±5.50)比(51.62±4.80)]和复合主要心脏不良事件率[(7.41%(4/54)比5.56%(3/54)比较,差异均无统计学意义。研究组总出血率为11.11%(6/54),低于对照组[37.04%(20/54)],两组比较,差异有统计学意义(χ^(2)=9.929,P=0.048)。结论行PCI的老年STEMI患者,低剂量和标准剂量的替罗非班对血小板聚集、冠状动脉血流、左室收缩功能及短期疗效的临床结果影响的作用相似,而低剂量方案的出血率显著低于标准剂量方案。To explore the efficacy and safety of intracoronary and intravenous tirofiban at a low dose for elderly patients with acute ST elevation myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention(PCI).Methods One hundred and eight(73.68±3.51)years old patients with STEMI undergoing PCI at Guangzhou Red Cross Hospital from June,2016 to February,2019 were selected,including 69 males and 39 females.They were divided into a control group and a study group by the random number table method,with 54 cases in each group.All the patients took intracoronary injection of tirofiban 10.000μg/kg after coronary artery reperfusion;the control group intravenously took tirofiban at 0.150μg/(kg·min),and the study group at 0.075μg/(kg·min),for 24 h.After the operation,the proportions of the patients with complete ST segment resolution,the peaks of high-sensitive cardiac troponin T,the thrombus scores of infarction-related arteries,blood flow of thrombolysis in myocardial infarction(TIMI)after PCI,bleeding events,left ventricular ejection fractions 90 d after PCI,and major adverse cardiovascular events in the two groups were observed.Results There were no statistical differences in the clinical characteristics between the control group and the study group(all P>0.05).There were no statistical differences in the proportion of the patients with complete ST segment resolution[87.04%(47/54)vs.88.89%(48/54)],peak of high-sensitive cardiac troponin T[(4.80±1.80)μg/L vs.(5.20±2.30)μg/L],the thrombus score of infarction-related arteries[(0.90±0.55)vs.(1.08±0.59)],the number of the patiens with grade 3 blood flow of TIMI after PCI(48 cases vs.49 cases),left ventricular ejection fraction 90 d after PCI[(50.34±5.50)vs.(51.62±4.80)],and incidence of major adverse cardiac events[7.41%(4/54)vs.5.56%(3/54)]between the control group and the study group,with no statistical differences(all P>0.05).The total bleeding rate in the study group was lower than that in the control group[11.11%(6/54)vs.37.04%(20/54),χ^(

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 替罗非班 心脏不良事件 

分 类 号：R542.22[医药卫生—心血管疾病]