不同剂量替罗非班在急性ST段抬高型心肌梗死患者急诊介入治疗早期应用的疗效评价

Clinical evaluation of different doses of Tirofiban applied in early stage for interventional therapy of STEMI patients

目的:探讨直接介入术早期应用不同剂量替罗非班对急性ST段抬高型心肌梗死(STEMI)患者术后的临床疗效。方法:连续入选确诊STEMI行PCI治疗患者,随机分为大剂量组(予替罗非班25μg/kg的负荷剂量静脉推注)、常规剂量组(予替罗非班10μg/kg的负荷剂量静脉推注)及对照组,每组60例。观察术前、术后罪犯血管的TIMI分级血流及心功能[术后住院期间及术后30d左室射血分数(LVEF)、脑利钠肽(BNP)]。对术后住院期间出血事件发生率进行安全性评价。对住院期间及术后30d患者主要不良心脏事件(MACE)进行随访。结果:大剂量组、常规剂量组患者术前罪犯血管的TIMI血流分级均优于对照组(P<0.001,P=0.032),且大剂量组患者术前罪犯血管的TIMI血流分级优于常规剂量组(P=0.037)。3组术后TIMI血流分级及慢血流发生率比较差异无统计学意义。术后心功能显示,住院期间大剂量组和常规剂量组LVEF、BNP较对照组明显改善(P<0.05),且大剂量组较常规剂量组LVEF、BNP改善更明显(P<0.05);3组术后30d的LVEF、BNP比较差异无统计学意义。3组出血事件的发生率比较差异无统计学意义。大剂量组和常规剂量组术后MACE发生率明显低于对照组(P<0.05),而大剂量组与常规剂量组比较差异无统计学意义。结论:急性STEMI患者早期使用替罗非班,可以改善PCI术前TIMI血流分级、早恢复PCI术后住院期间心功能及减少MACE发生率,且上游大剂量应用替罗非班改善术前TIMI血流分级及恢复PCI术后住院期间心功能更加明显。

Objective：To discuss the clinical efficacy of different doses of Tirofiban applied in early stage for interventional therapy of STEMI patients.Method：One hundred and eighty consecutive patients were randomly assigned to 3groups,high dose group（intravenous infusion 25μg/kg of loading dose of Tirofiban）,conventional dose group（intravenous infusion 10μg/kg of loading dose of Tirofiban）and control group.Efficacy evaluation was made by observing the TIMI flow grades of the culprit vessel and cardiac function（LVEF and BNP during the hospitalization and 30 days after the interventional therapy）preoperatively and postoperatively.Security evaluation was measured by the prevalence of bleeding during the postoperative hospitalization.Follow-ups were arranged by observing the incidence of in-hospital MACE in the postoperative 30 days.Result：Preoperative TIMI flow grades of culprit vessel of high dose group and conventional dose group were obviously superior to that of control group（P〈0.001,P=0.032）,and preoperative TIMI in high dose group was superior to conventional dose group（P=0.037）.There was no significant difference in the TIMI flow grades and incidence of slow reflow phenomenon after PCI among the three groups.Compared with the control group,the postoperative cardiac function（LVEF and BNP）of high dose group and conventional dose group were improved（P〈0.05）,and LVEF and BNP in high dose group was superior to conventional dose group（P〈0.05）.However,there was no significant difference in the LVEF and BNP 30 days after the PCI and the prevalence of bleeding.Postoperative incidence of MACE of high dose group and conventional dose group was significantly lower than those of control group（P〈0.05）.There was no significant difference between high dose group and conventional dose group in postoperative incidence of MACE.Conclusion：Application of Tirofiban in early stage for STEMI patients can improve the TIMI flow grades and postoperative recovery of cardiac function,and reduce the incidence of MACE.Moreover,high-dose tirofibanexerts a better therapeutic effect.