急性冠状动脉综合征介入治疗联合应用盐酸替罗非班对围手术期转归的影响

Impacts on Peri-procedure Outcome of Patients with Acute Coronary Syndrome Undergone Percutaneous Coronary Intervention when Combined with Intravascular Tirofiban Administration

目的:探讨在急性冠脉综合征(ACS)患者病程中常规治疗联合应用盐酸替罗非班对心肌组织水平再灌注与围PCI术期严重心脏不良事件(MACE)的影响。方法:2005—2006年间15例在急诊或择期PCI术前具有形成血栓的高危因素或PCI术时发现慢血流现象或血栓的ACS患者,在术前、术中或术后应用盐酸替罗非班,按推荐剂量经外周静脉或冠脉内直接注入药物,观察15～20min后相关血管的血栓征象、血栓负荷、TIMI分级情况、术后MACE及出血并发症等。结果:15例ACS患者,男性13例,女性2例,年龄44～75岁,起病时间在数小时至数天。全部患者术中即刻造影均未见有明显的新发血栓形成,原有新鲜血栓消失,肇事血管前向血流由TIMI0～2级恢复至TIMI3级。术后14例患者术后一般情况稳定,症状明显改善或消失,住院期间未发生MACE与出血并发症,但有1例患者在住院期间因心源性休克、多器官功能衰竭死亡。结论:对ACS介入治疗围手术期存有靶血管高危因素存在(如慢血流、血栓等征象)的患者,经冠脉或外周静脉应用盐酸替罗非班有助于改善心肌组织再灌注水平,减少围手术期血栓并发症所致的MACE发生。

Objective：To explore the effects of introvascular administration of tirofiban compared with the standard application in patients with acute coronary syndrome（ACS） peri-procedure of percutaneous coronary intervention. Methods： Fifteen ACS pa tients who were to receive or receiving primary PCI were assigned to intravenous tirofiban application by recommended dose if there were in high risk of target vessel thrombosis or slow flow. The patients were observed on instant new thrombosis, thrombus load, TIMI grade, main adverse cardiac events（MACE） and haemorrhage complications during hospitalization. Results： Totally 15 ACS patients （13 males, 2 females, aged 44 75 years） were observed in the study. During PCI, all the target vessels showed improvement of TIMI flow grade from TIM 0-2 to TIMI 3, disappearance of previous culprit thrombus on immediate angiography after tirofiban administration for 15 20min. The clinical general conditions of 14 patients were stable and evidently improved with no MACE and haemorrhage complications, while one patient died of cardiac shock complicating multiorgan failure during hospitalization. Conclusion： In patients of ACS with high risk of target vessel thrombosis or low TIMI grade primary PCI, intravenous or intracoronary tirofiban administration may be favorable for myocardial reperfusion and reduction in MACE complicating peri-procedure thrombosis.