替罗非班在急诊经皮冠状动脉介入术中抗血栓作用的疗效及安全性

Observation of Antithrombotic Efficacy of Tirofiban during PCI

目的评价国产替罗非班(tirofiban)在经皮冠状动脉介入术(PCI)中消除冠脉内血栓的安全性及有效性。方法选择接受急诊PCI术中有较大量血栓负荷的患者12例,其中2例为溶栓失败后补救性PCI(rescue PCI)。经桡动脉途径PCI常规处理梗死相关动脉(IRA),在PCI术中给予国产替罗非班10μg/kg的负荷量,然后给予0．15μg·kg^(-1)·min^(-1)的剂量持续静滴24h。如出现皮下出血或是其他出血倾向时可减半量输入。对比给药1h前、后的造影结果。术后常规给予抗血小板药物口服、术后给予肝素500～1000U/h泵入24h,监测患者的活化部分凝血活酶时间(APTT)始终在治疗前的1．5～2．5倍,之后以低分子肝素克赛1mg/kg皮下注射,1次/12h,5～7d。观察手术成功率、血栓积分、围术期和出院3个月后患者的出血并发症及主要心脏不良事件(死亡、急性心肌梗死、紧急血运重建)的发生率。结果12例患者PCI均取得成功,血栓明显消退,治疗前、后血栓评分间差异有非常显著性意义(P＜0．01),手术成功率为100%,无死亡、再发心梗及靶血管再次血运重建。结论替罗非班在急诊PCI治疗急性心肌梗死中应用安全有效,且具有较强的抗血栓效果,可明显降低冠脉内血栓评分。

Objective To evaluate the efficacy and safety of tirofiban in patients with cornary artery disease during percutaneous coronary intervention （PCI）. Methods 12 patients with emergency coronary thrombosis during emergency PCI, 2 patients were rescue PCI. Tirofiban was injected into thrombotic coronary with 10μg/kg in 3 minutes, then was infused intrave- nously with 0. 15μg·kg^-1·min^-1 for 24 hours. The major adverse cardiac events （angina, death, re -infarction of target lesion and revascularization of target lesion） and rate of bleed complications was observed in hospital and 3 months. Results PCI of 12 patients were doing well, achievement ratio was 100%, with no angina, death, re -infarction of target lesion and revas- cularization of target lesion. Conclusion The intracoronary and intravenously administration of tirofiban in patients with coronary thrombosis was safe, and more effective in removing coronary thrombus.