替罗非班在急性冠脉综合征高危患者中的临床应用

Clinical application of platelet GP Ⅱb/Ⅲa receptor antagonist tirofiban to high-risk acute coronary syndrome patients

目的对使用替罗非班的急性冠脉综合征高危患者的临床资料进行分析，以评价该药的临床疗效及安全性。方法急性冠脉综合征高危患者79例，在阿司匹林、氯吡格雷及肝素或低分子肝素联合强化抗凝抗血小板治疗的基础上予以负荷量替罗非班10μg／kg静脉推注大于3分钟，继之以0．10～0．15μg／kg·min速度维持24～36小时。对其中的ST段抬高心肌梗塞和非ST段抬高急性心肌梗塞及不稳定心绞痛患者中的极高危者，进行急诊冠脉介入干预。结果院内心绞痛发作5例，心肌梗塞或再梗2例，死亡6例，颅内出血1例，其它出血并发症8例，大多为轻微出血。58例接受冠脉介入治疗，39例造影时冠脉血流达到TIMI3级，8例术中出现无复流或慢血流现象。介入治疗患者无一例院内发生急性或亚急性支架内血栓形成。结论替罗非班是一种具有明确疗效且安全性较好的抗血小板药物，尤其在急性冠脉综合征高危患者及介入治疗围手术期联合使用替罗非班强化抗血栓治疗，对改善患者预后具有重要意义。

Objective To analyze the clinical data of high-risk acute coronary syndrome patients administrated with platelet GP Ⅱb/Ⅲa receptor antagonist triofiban and evaluate the efficacy and the safety of tirofiban. Methods 79 high-risk acute coronary syndrome patients were administrated with bolus intravenous injection of tirofiban at 10μg/kg, and continuous infusion at 0.10-0. 15μg/kg/min for 24-36 hours. Patients having ST elevation myocardial infarction and the extremely high-risk non-ST elevation myocardial infarction/unstable angina underwent emergency percutaneous coronary intervention（PCI）. Results Five patient had episode of angina, 2 had myocardial infarction or reinfarction, 6 deaths, 1 had intracranial hemorrhage, 8 had other sites of hemorrhage-induced complications, most of whom were minor hemorrhage. 58 patients underwent PCI, in whom 39 achieved TIMI 3-grade of coronary flow by angiography, 8 had no flow or slow flow during intervention. No acute or subacute stent thrombosis was observed after intervention. Conclusion Tirofiban is an antiplatelet regimen with definite efficacy and safety, especially for high-risk acute coronary syndrome and pri-PCI patients. The antithrombotic therapy combined with tirofiban has important implication in improving clinical outcome.