急性心肌梗死患者介入术中冠脉内应用替罗非班的疗效和安全性评价

Evaluation on the safety and efficacy of tirofiban intracoronary injection in patients with acute myocardial infarction treated by primary percutaneous coronary intervention

目的：观察急性心肌梗死患者介入治疗术中冠脉内应用盐酸替罗非班的疗效和安全性。方法：60例急性心肌梗死患者随机分为2组，试验组32例，对照组28例，均于发病12h内行急诊PCI术。试验组PCI术中冠脉内注入盐酸替罗非班10ml，静脉维持量0．15μg／kg·min36h。对照组PCI术中静脉负荷量0．4μg／kg·min 30min，维持量0．15μg／kg·min36h。两组患者PCI术中均给予肝素8000～10000U，PCI术前服用氯吡格雷300mg，阿司匹林300mg，术后各75mg/d。观察PCI术前、术后梗死相关血管TIMI血流情况，术后4周内并发症及主要不良心脏事件的发生情况。结果：试验组PCI术后慢复流发生率及主要不良心脏事件的发生率均低于对照组，差异有统计学意义（P〈0．05），出血并发症的发生与对照组差异无统计学意义（P〈0．05）。结论：冠脉内应用盐酸替罗非班能改善急性心肌梗死患者PCI术后梗死相关血管的TIMI血流，减少PCI术后主要不良心脏事件的发生率，临床应用安全有效。

Objective： To evaluate the safety and efficacy of tirofiban intracoronary injection in patients with acute myocardial infarction （AMI） treated by primary percutaneous coronary intervention （PCI）. Methods： 60 AMI patients were randomly divided into two groups： 32 patients in test group and 28 in control group. All the individuals were performed PCI within 12 hours after onset of AMI. All the test group individuals were injected Tirofiban （10mg） into the infarction related artery（IRA） during PCI and intravenously administered Tirofiban 36 hours （0. 15ug/kg. min） after PCI. All the contral group individuals were intravenously administered Tirofiban 36 hours （0.15ug/kg. min） following a loading dose 30 mins （0.4ug/kg. min）. All the individuals were intravenous administered heparin 8000-10000U during PCI and were given oral bolus dose of Clopidogrel 300mg before PCI and Clopidogrel 75mg per day, Aspirin 75mg per day after PCI. Thrombolysis in acute myocardial infarction （TIMI） grade was studied before and after PCI. The major adverse cardiac events （MACE） at 4 weeks and bleeding complications were studied . Results： In test group, the occurance of slow-reflow and MACE at 4 weeks were lower than those in control group , The occurance of bleeding complication In Tirofiban group was the same as those in control group, there was no significant difference in both groups. Conclusion ： Application of Tirofiban intracoronary injection during primary PCI in patients with AMI was safe and effective, which may reduce the occurrence of MACE,and improve TIMI flow of IRA in patients with AMI during primary PCI .