盐酸替罗非班在ST段抬高急性心肌梗死急诊PCI中的安全性分析

The safety study of tirofiban in patients with STEMI during emergency PCI

目的:评价GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班(商品名欣维宁)在ST段抬高急性心肌梗死(STEMI)急诊经皮冠状动脉腔内介入术(PCI)治疗中的安全性。方法:65例急诊入院STEMI行急诊PCI患者,分为试验组(盐酸替罗非班+PCI)36例和对照组(直接PCI29例)。观察2组住院期间主要心血管事件(MACE)包括死亡、新近心肌梗死和顽固缺血状态、术后左心室射血分数(LVEF)、压迫止血时间及不良反应(出血、血小板减少)。结果:住院期间主要心血管事件(majoradversecardiovascularevents,MACE)发生率,试验组低于对照组(5.6%比13.7%);术后LVEF(59.42±8.06比52.65±5.20)高于对照组;2组均未发生严重出血并发症(包括大量出血和颅内出血等),出血事件发生率试验组较对照组有增多的趋势(11.1%比3.4%),试验组部分凝血活酶时间(activatedpar_tialthromboplastintime,APTT)较对照组延长(58.15±11.86比33.78±11.28),(P<0.05);压迫止血时间明显延长(37.25±6.34比20.12±5.55),(P<0.05),但未增加穿刺点出血和血肿。结论:血小板GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班联合PCI可能成为STEMI患者急诊PCI安全和有效的再灌注手段。

Objective：To assess the safety of GPⅡb/Ⅲa antagonists tirofiban in patients with STEMI during emergency PCI. Method：65 patients with STEMI during emergency PCI, divided into two groups, tirofiban ＋ PCI group（ n = 36）and primary PC1 group（ n = 29）. Compare two groups major adverse cardiovascular events （MACE） rates consisted of death, new onset myocardial infarction, persistent myocardial ischacmic state, after operation Cardiac function （left ventricular ejection fraction ）, compression hemostasia time and adverse drug effect in hospital. Result： Major adverse cardiovascular events （MACE） rates in hospital tirofiban ＋ PCI group was lower than that of primary PCI group（5.6% vs13.7%）;Postoperative heart function was better in tirofiban ＋ PCI group than that in primary PCI group（59.42 ± 8.06 vs 52.65 ± 5.20） ;There was no difference in severe hemorrhage between the two groups.The bleeding events rates was added tendency of tirofiban ＋ PCI group. （ 11.1% vs 3.4%）. APTr and compression hemostasia time of tirofiban ＋ PCI group were significant prolonged （58.15 ± 11.86 vs 33.78 ± 11.28, P〈0.05）（37.25 ± 6.34 vs 0.12 ± 5.55, P 〈 0.05）, but no more bleeding and hematom event occurred. Conclusion： GPⅡb/Ⅲa a antagonists tirofiban ＋ PCI is possible to become safe and effective reperfusion method with STEMI during emergency PCI