替罗非班对急性心肌梗死患者急诊PCI治疗疗效的影响

Effect of Tirofiban on primary emergency percutaneous coronary intervention result in patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者急诊冠状动脉介入治疗(PCI)不同时间应用替罗非班PCI疗效的差别。方法选择急诊入院的60例AMI患者随机分为早期治疗组(n=30)与晚期治疗组(n=30),早期治疗组于急诊入院即刻静脉给予替罗非班;晚期治疗组于冠状动脉造影后静脉给替罗非班。比较两组患者PCI术前后的TIMI血流分级、TIMI心肌灌注分级(TIMI myocardial perfusion grade,TMPG)、血小板聚集率及出血情况。记录住院期间及随访3个月时的主要心血管事件(心源性死亡、非致死性心肌梗死及再发性心绞痛、主要心脏不良事件)的发生率。结果(1)术前TIMI前向血流达到3级的比例:早期治疗组明显高于晚期治疗组;术后两组差异无统计学意义。(2)术前和术后的TMPG 2-3级比例:早期治疗组均显著高于晚期治疗组。(3)术后血小板聚集率:两组患者均较术前明显下降,两组之间差异无统计学意义。结论AMI患者入院时尽早应用替罗非班对急诊PCI治疗是安全有效的,且能够更明显改善靶血管前向血流TIMI分级及心肌灌注TMPG分级。

Objective To evaluate the effect of Tirofiban on primary emergency percutaneous coronary intervention （PCI） result in patients with acute myocardial infarction （AMI）. Methods Sixty AMI patients on admission in emergency room were divided into two groups： early group （receive Tirofiban on admission） and late group （receive Tirofiban after angiography）. TIMI grade, TIMI myocardial perfusion grade （TMPG）, platelet aggregation rate and bleeding in both groups were observed and compared before and after PCI. Adverse cardiovascular events were also recorded in hospital and during 3 months＇ follow-up. Results Before PCI, TIMI 3 flow rate was significantly higher in early group than in late group. However, TIMI 3 flow rate after PCI was not significantly different between early group and late group. TMPG 2 - 3 rate was higher in early group than in late group, whether compared before PCI or after PCI. Platelet aggregation rate after PCI was lower than before PCI in both groups, there was no difference between groups. Conclusions Early use of Tirofiban could significantly improve forward blood （low in target vessels. It is effective and safe in AMI patients treated with primary PCI.