替罗非班在急诊PCI前后给药对急性心肌梗死患者心肌灌注及近期预后的影响  

Effects of tirofiban administrated before and after emergency PCI on myocardial perfusion and short-term prognosis in patients with acute myocardial infarction

作　　者：王育林[1] 程景林[1] 李雪翔[1] 周姝[1] WANG Yu-lin;CHENG Jing-lin;LI Xue-xiang;ZHOU Shu(Department of Emergency Medicine,the Second Afiliated Hospital of Anhui Medical University,Hefei ANHUI 230001,China)

机构地区：[1]安徽医科大学第二附属医院急诊内科,安徽合肥230001

出　　处：《中国新药与临床杂志》2023年第8期537-541,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的探究急诊经皮冠状动脉介入治疗(PCI)不同时机使用替罗非班对急性心肌梗死(AMI)患者心肌灌注及近期预后的影响。方法选取104例行PCI的AMI患者,按照随机数字表法均分为2组。A组于冠脉造影前1~2 h静脉注射替罗非班10μg·kg^(-1),B组于PCI完成后即刻静脉注射替罗非班10μg·kg^(-1),后均以替罗非班0.15μg·kg^(-1)·min^(-1)维持至术后36 h。术后随访6个月,比较2组心肌损伤标志物[肌酸激酶同工酶(CK-MB),肌钙蛋白(c Tn T)]、心功能[左室舒张末期内径(LVEDD),左室收缩末期内径(LVESD),左室射血分数(LVEF)]、ST段回落情况、心肌灌注变化、并发症及不良心血管事件发生率。结果与治疗前比较,发病24 h时2组c Tn T均达到最高峰,发病48 h、治疗后7 d时2组c Tn T均下降,且A组低于B组(P<0.05);治疗后7 d,2组血清CK-MB水平均下降,且A组低于B组(P<0.05)。治疗后7 d,A组LVEDD、LVESD低于B组,LVEF高于B组(P<0.05)。治疗后90 min A组ST段回落值、完全回落率高于B组(P<0.05)。治疗前2组心肌灌注分级无显著差异(P>0.05),治疗后6个月A组心肌灌注分级优于B组(P<0.05),2组穿刺部位局部血肿、消化道出血、牙龈出血发生率无显著差异(P>0.05),A组再灌注心率失常发生率低于B组(P<0.05),而心绞痛、心肌梗死复发率与B组比较无显著差异(P>0.05)。结论AMI患者PCI前应用替罗非班治疗较术后用药效果好,能有效提升患者心肌灌注,改善预后。AIM To investigate the effects of tirofiban used at different times of emergency percutaneous coronary intervention(PCI)on myocardial perfusion and short-term prognosis in patients with acute myocardial infarction(AMI).METHODS A total of 104 patients with AMI who underwent PCI were selected and divided into the group A(n=52)and the group B(n=52)according to the random number table.In the group A,tirofiban 10μg·kg^(-1) was injected intravenously within 3 min at 1-2 h before coronary antiography,and in the group B,tirofiban 10μg·kg^(-1) was injected intravenously immediately after the completion of PCI,and then tirofiban(0.15μg·kg^(-1)·min^(-1))was continuously pumped intravenously for 36 h.Myocardial injury markers(creatine phosphokinase isoenzyme(CK-MB),troponin T(cTnT)),cardiac function(left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF)),ST-segment reduction and myocardial perfusion changes,complications and the incidence of adverse cardiovascular events were compared between the two groups.RESULTS Compared with those before treatment,cTnT in both groups reached the peak at 24 h after onset,and decreased at 48 h of onset and 7 days after treatment,and cTnT in the group A was lower than that in the group B(P<0.05).After 7 days of treatment,serum CK-MB levels decreased in both groups,and were lower in the group A than in the group B(P<0.05).After 7 days of treatment,LVEDD and LVESD in the group A were lower than those in the group B,but LVEF was higher than that in the group B(P<0.05).At 90 minutes after treatment,ST segment reduction value and complete reduction rate in the group A were higher than those in the group B(P<0.05).There was no significant difference in myocardial perfusion grade between the two groups before treatment(P>0.05),and myocardial perfusion grade in the group A was better than that in the group B after 6-month of treatment(P<0.05).There was no significant difference in the incidence of gingival bleedin

关 键 词：心肌梗死 替罗非班 经皮冠状动脉介入治疗 心肌再灌注 预后 

分 类 号：R973.2[医药卫生—药品]