替罗非班冠状动脉内注射治疗STEMI患者PCI术中无复流或慢血流的效果及安全性  

Efficacy and safety of tirofiban intracoronary injection in the treatment of STEMI patients without reflow or slow blood flow during PCI

作　　者：王小龙[1] 孙胜 谢地成 马文超 丁治英[1] 刘同祥[1] WANG Xiaolong;SUN Sheng;XIE Dicheng;MA Wenchao;DING Zhiying;LIU Tongxiang(Emergency Department of Weifang People′s Hospital,Shandong Province,Weifang 261000,China)

机构地区：[1]山东省潍坊市人民医院急诊部,261000

出　　处：《临床合理用药》2025年第3期5-8,共4页Chinese Journal of Clinical Rational Drug Use

基　　金：潍坊市卫健委科研项目(WFWSJK-2020-007)。

摘　　要：目的 观察替罗非班冠状动脉内注射治疗ST段抬高心肌梗死(STEMI)患者经皮冠脉介入治疗(PCI)术中无复流或慢血流的效果及安全性。方法 回顾性选取2021年3月—2022年3月潍坊市人民医院急诊入院行PCI治疗的STEMI患者128例,按照治疗用药不同分为观察组(n=64)与对照组(n=64)。2组均常规应用β受体阻滞剂和血管紧张素转换酶抑制剂等药物、注射用比伐芦定(术前、术后)治疗,术后给予阿司匹林肠溶片、替格瑞洛片治疗。在此基础上,观察组术中给予盐酸替罗非班氯化钠注射液,对照组术中给予0.9%氯化钠注射液。比较2组术前、支架植入完成即刻、术后即刻冠状动脉血流分级,主要不良心血管事件(MACE)及出血情况。结果 2组术前、支架植入完成即刻心肌梗死溶栓试验分级(TIMI)≤2级及校正的TIMI帧数(CTFC)≥40者占比比较,差异无统计学意义(P>0.05);观察组术后即刻TIMI≤2级及CTFC≥40者占比均低于对照组(12.50%vs. 26.56%、9.38%vs. 23.44%,χ^(2)/P=4.026/0.045、4.614/0.032)。观察组MACE总发生率低于对照组(9.38%vs. 23.43%,χ^(2)=4.614,P=0.032)。观察组与对照组出血总发生率比较,差异无统计学意义(23.44%vs. 21.88%,χ^(2)=0.045,P=0.833)。结论 行PCI治疗的STEMI患者,在常规药物治疗基础上冠状动脉内注射替罗非班的疗效显著,且不增加出血及血小板减少风险,安全性较高。Objective To observe the efficacy and safety of tirofiban intracoronary injection in the treatment of STEMI patients without reflow or slow blood flow during PCI.Methods A total of 128 patients with STEMI who were admitted to the Emergency Department of Weifang People′s Hospital for PCI treatment from March 2021 to March 2022 were retrospectively enrolled,and they were divided into the observation group(n=64)and the control group(n=64)according to different treatment drugs.Both groups were routinely treated withβ-blockers,ACE inhibitors and other drugs,bivalirudin for injection(preoperative and postoperative),and treated with aspirin enteric-coated tablets and ticagrelor tablets after surgery.On this basis,the observation group was given tirofiban hydrochloride sodium chloride injection intraoperatively,and the control group was given 0.9%sodium chloride injection intraoperatively.The coronary blood flow grade before surgery,immediately after stent implantation and immediately after surgery,MACE and bleeding conditions were compared between the two groups.Results There were no significant difference in the percentage of patients with number of TIMI≤2 grade and CTFC≥40 before surgery and immediately after stent implantation between the two groups(P>0.05).The percentage of patients with number of TIMI≤2 grade and CTFC≥40 in the observation group were lower than those in the control group(12.50%vs.26.56%vs.9.38%vs.23.44%,χ^(2)/P=4.026/0.045,4.614/0.032).The total incidence of MACE in the observation group was lower than that in the control group(9.38%vs.23.43%,χ^(2)=4.614,P=0.032).There was no significant difference in the total incidence of bleeding between the observation group and the control group(23.44%vs.21.88%,χ^(2)=0.045,P=0.833).Conclusions STEMI patients treated with PCI,intracoronary tirofiban on the basis of conventional drug therapy has significant efficacy,and do not increase the risk of bleeding and thrombocytopenia,and with higher safety.

关 键 词：ST段抬高心肌梗死 替罗非班 比伐芦定 无复流 慢血流 

分 类 号：R54[医药卫生—心血管疾病]