不同给药途径应用替罗非班在急性 ST 段抬高型心肌梗死急诊经皮冠状动脉介入术中的效果比较

Comparison of the effect of different ways of using tirofiban in patients with acute ST segment elevation myo-cardial infarction undergoing percutaneous coronary intervention

目的：研究替罗非班静脉内注射、冠状动脉内注射两种不同给药途径在急性 ST 段抬高型心肌梗死急诊 PCI 中的应用价值。方法选取行急诊 PCI 的急性 ST 段抬高型心肌梗死患者108例为研究对象，将患者按随机数字表法分为观察组和对照组，各54例，观察组 PCI 治疗时通过冠脉内注射首剂量替罗非班，对照组通过静脉内注射，比较两组治疗后的血管造影结果、心电图、实验室相关指标及不良事件发生情况。结果观察组治疗前 TIMI 2级及3级比率、初始校正 TIMI 计帧数明显低于对照组，差异有统计学意义（χ2／t ＝4．32、4．59、5．25，均 P ＜0．05），观察组在治疗后 MBG 2级或3级比率、术后校正 TIMI 计帧数明显高于对照组，差异有统计学意义（χ2／t ＝4．11、4．85、5．87，均 P ＜0．05）。观察组 PCI 治疗术后1 h ST 完全回落例数、EF增加值、室璧运动分数指数增加值分别为53例、（8．02±6．94）％、（0．41±0．28），均明显高于对照组的36例、（5．87±6．54）％、（0．28±0．27）（χ2／t ＝5．32、4．32、3．65，均 P ＜0．05）。两组不良事件发生情况差异无统计学意义（χ2＝0．52，P ＞0．05）。结论与静脉内注射的给药途径相比，替罗非班冠状动脉内给药可改善急性ST 段抬高型心肌梗死患者 PCI 治疗术后心肌灌注水平，促进左室功能恢复，且安全性高。

Objective To study tirofiban intravenous injection,coronary artery injection of the two different methods in acute ST segment elevation myocardial infarction,the application of emergency PCI.Methods Patients underwent emergency PCI with acute ST segment elevation myocardial infarction as the research subjects,a total of 108 cases,the patients were randomly divided into the observation group and control group,54 patients in each group. In the observation group,the first dose of tirofiban was injected into the coronary artery.The control group was treated by intravenous injection.The results of the two groups were compared.Results Before treatment,TIMI level 2 and level 3 ratio,initial corrected TIMI frame count of the observation group were significantly lower than the control group （χ2 /t =4.32,4.59,5.25,all P 〈0.05）.After treatment,MBG level 2 or level 3 ratio,post -operative corrected TIMI frame count of the observation group were significantly higher than the control group （χ2 /t =4.11,4.85,5.87, all P 〈0.05）.1 h after PCI treatment,the number of cases of ST fully back,the added value of EF,plague index scores of observation group were 53 cases,（8.02 ±6.94）%,（0.41 ±0.28）respectively,which were significantly higher than those of the control group 36 cases,（5.87 ±6.54）%,（0.28 ±0.27）（χ2 /t =5.32,4.32,3.65,all P 〈0.05）.Adverse events of the two groups had no significant difference （χ2 =0.52,P 〉0.05）.Conclusion Compared with intravenous injection,tirofiban in the treatment of acute ST segment elevation myocardial infarction by intracoronary injection can improve the level of myocardial perfusion after PCI operation,promote the recovery of left ventricular function,and has high security.