急性ST段抬高心肌梗死经皮冠状动脉介入治疗前应用替罗非班的效果

A Study on the Effect of Impact of Early Tirofiban Administration in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

目的:观察早期应用替罗非班对急性ST段抬高心肌梗死(STEMI)急诊行经皮冠状动脉介入治疗(PCI)对梗死相关血管的血流及梗死区心肌灌注的影响。方法:将114例发病<12小时急诊行PCI的急性STEMI患者随机分为早期组和晚期组,每组57例。早期组入急诊室PCI前即开始应用替罗非班,晚期组在PCI开始时应用替罗非班,替罗非班用法为10μg/kg静脉推注,继以0.15μg.kg-1.min-1维持至PCI后36小时。观察两组PCI前后心肌梗死溶栓(TIMI)分级及梗死区心肌灌注(TMP)分级、PCI后90天主要心血管事件(MACE)及术后出血发生情况。结果:早期组PCI前TIMI3级及TMP3级的获得率分别为31.6%、33.3%,晚期组分别为12.3%、14.0%;PCI后早期组分别为96.5%、75.4%,晚期组分别为94.7%、57.9%,两组PCI前TIMI3级、TMP3级及PCI后TMP3级比较差异均有统计学意义(P<0.05)。PCI后90天早期组3例发生MACE,占5.3%;晚期组9例发生MACE,占15.8%,差异无统计学意义(P>0.05)。结论:对急性STEMI急诊行PCI的患者,早期应用替罗非班能改善梗死相关血管的血流及心肌灌注。

Objective：We evaluated the effect of early Tirofiban on the coronary TIMI flow of IRA and myocardial reperfusion in patients with ST-segment elevation myocardial infarction（STEMI） undergoing primary percutaneous coronary intervention. Methods ：Patients （n = 114）with acuter STEMI presenting 〈 12 h from onset of symptoms were randomized to either early administration of tirofiban in the emergency room（n = 57 ）or later administration in the catheterization laboratory （n = 57）（ Tirofiban bolus dose of 10 μg/kg,followed by 0. 15 μg · kg^-1· min^-1 for 36 h after PCI）. The coronary TIMI flow and TMP of IRA before or after PCI,major adverse cardiac events （MACE） rates within 90 days,bleeding complications were assessed. Results： Compared with that of the later group, the incidence of TIMI grade 3 flow（31.6% vs 12.3% ）and TMP grade 3（33.3% vs 14.0% ） before PCI and TMP grade（96.5% ,75.4% vs 94.7% ,57.9% ） after PCI significantly increased in the early group. TIMI grade 3 flow before PCI and TMP grade 3 after PCI showed significant difference in the two groups（P 〈0. 05）. 3 cases had MACE in the early group and 9 in the later group（5.3% early,15.8% later）with no significant difference in the two groups （ P 〉 0. 05 ）. Conclusion： Early Tirofiban administration can improve the coronary TIMI flow of IRA and myocardial reperfusion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.