国产替罗非班对冠脉介入术后心肌微循环再灌注的疗效

Effects of tirofiban on improving myocardium reperfusion in patients after percutaneous coronary intervention

目的:观察国产替罗非班对直接经皮冠脉介入术(PCI)术后心肌微循环再灌注的疗效。方法:急性ST段抬高急性心肌梗塞(STEMI)直接PCI术病人95例,A组(45例)PCI术中给予国产替罗非班10μg/kg的负荷量,然后以0.15μg/kg·min静脉滴注维持18 h,B组(50例)术中不予替罗非班,两组患者均在PCI术后常规给予抗血小板药物口服、肝素泵入,对比给药前后的TIMI血流分级、校正的TIMI帧数(CTFC)及术前、术后ST段回落率及室壁运动记分(WMSI),围术期出血倾向。结果:A组患者治疗后TIMI血流分级、校正的TIMI帧数、ST段完全回落率明显优于B组(P<0.05),随访1月时,两组患者WMSI、EF均有改善,但A组的WMSI较B组改善更多(P<0.05),A组治疗期间轻微出血发生率高于B组(P<0.05)。结论:在阿司匹林和氯吡格雷基础上早期应用替罗非班,可减少STEMI再灌注后无再流或慢血流的发生,改善心肌微循环再灌注及病人预后。

Objective： To evaluate the effects of tirofiban on myocardium reperfusion after primary percutaneous coronary intervention （PCI）. Methods： A total of 95 patients with ST elevation acute myocardial infarction, who underwent primary PCI, were randomized into two groups. Forty-five patients in group A were treated with tirofiban （10μg/kg bolus, 0. 15 μg/kg · min infusion for 18 h）. Fifty patients in group B were treated routinely without tirofiban. All patients received antiplatelet preparation and intravenous heparin; the change of TIMI blood flow, corrected TIMI frame count （CTFC）, degree of ST-segment recovery, ventricular wall motion score index （WMSI）, rate of bleeding complication were compared between two groups. Results： TIMI blood flow, CTFC, degree of ST--segment recovery after treatment in group A were significant superior to group B （P〈0. 05）. The WMSI and EF significantly improved at one month in both groups, but the ΔWMSI in group A were significantly higher than that of group B （P〈0. 05）. There was increase of minor bleeding complication in group A （P〈0.05）. Conclusion： Early application of tirofiban before primary PCI can decrease the probability of no-flow and slow-flow phenomenon, improve myocardial tissue reperfusion and the prognosis remarkably.