替罗非班对直接经皮冠状动脉介入治疗患者心肌灌注及疗效的影响

Effect of tirofiban on myocardial perfusion and clinical outcomes of patients receiving direct percutaneous coronary intervention

目的探讨替罗非班对直接经皮冠状动脉介入治疗(PCI)患者心肌灌注及疗效的影响。方法收集我院2005年6月至2006年4月因急性心肌梗死(AMI)住院的患者105例,分为甲组(54例,予直接PCI+替罗非班)和乙组(51例,仅予直接PCI)。比较两组直接PCI后心肌微循环灌注、心功能和心脏事件发生率。结果甲组术后TIMI血流3级、TMP血流3级的例数分别为49例(91％)和43例(80％),乙组分别为47例(92%)和39例(76％);两组间的差异均无统计学意义(P值均>0．05)。两组术后1h及3 d心电图梗死相关导联ST段回落>50％的例数和术后1周靶血管急诊PCI后病变处心肌显像良好例数的差异均有统计学意义(P值均< 0．05)。两组住院期间和随访期间各项心脏事件发生率分别为0．2％(1例)和17．6%9例,差异有统计学意义(P<0．05)。住院期间,甲、乙两组左室射血分数(LVEF)分别为(54±6)％和(53±3)％,左室收缩期末直径(ES)分别为(32±7)mm和(34±3)mm,左室舒张期末直径(ED)分别为(51±6)mm和(52±4)mm,差异均无统计学意义(P值均>0．05)。随访期间,两组LVEF分别为(58±6)％和(53±2)%,ES分别为(31±8)mm和(36±6)mm,ED分别为(52±1)mm和(55±2)mm,差异均有统计学意义(P值均<0．05)。结论晚期静脉应用替罗非班对改善直接PCI患者心肌灌注是安全、有效的,能显著减少心脏事件的发生及改善心功能。

Objective To appraise the effect of tirofiban on myocardial perfusion and clinical outcome of patients receiving direct percutaneous coronary intervention（PCI）. Methods One hundred and five AMI patients were enrolled in the present study from June 2005 to April 2006. The patients were divided into group A （tirofiban ＋ direct PCI, n = 54） and group B（direct PCI, n = 51）. The myocardial microcirculatory perfusion, cardiac function and the incidence of cardiac events between these two groups were compared. Results There were 49 cases reached TIMI3 blood flow in group A and 47 in group B. In group A, 43 cases attained TMPI3 blood flow and 39 cases in group B （P 〉 0.05）. The recovery of ST segment was significantly different between two groups one hour and three days after operation （P 〈 0.05）. Myocardial imaging was assessed by ^99mTc-sestamibi SPECT and the cases of good perfusion were also significantly different （P 〈 0.05）. There was no significant difference （P〉 0.05） in various cardiac events between the 2 groups during in-hospital and follow up periods, but the main adverse cardiac events （MACE） were significantly different （P 〈 0.05）. As to in-hospital period, the EF was （54 ± 6） % vs （53 ±3）% ; ES was （32 ± 7） mm vs （34 ± 3） mm, and ED （51 ± 6） mm vs （52 ± 4） mm in group A and B, respectively （P all 〉 0.05） ; during follow-up, EF was （58 ± 6） % vs （53 ± 2） % ; ES （31 ± 8） mm vs （36 ±6） mm; ED （52 ± 1） mm vs （55 ± 2） mm, （P all 〈 0.01）. Conclusion Late administration of tirofiban can improve myocardial perfusion, improve cardiac function and reduce the incidence of cardiac events, and it is safe and efficacious. （Shanghai Med J, 2007, 30..329 332）