替罗非班在急性心肌梗死患者急诊介入治疗术中的疗效和安全性评价

Evaluation on the Safety and Efficacy of Tirofiban in Patients with Acute Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

目的观察盐酸替罗非班在急性 ST 段抬高型心肌梗死患者急诊介入治疗术中的疗效和安全性。方法 58例急性 ST 段抬高型心肌梗死患者随机分为2组,其中盐酸替罗非班(欣维宁)组30例,对照组28例,均于发病12 h 内行急诊经皮冠状动脉介入治疗术(PCI)。盐酸替罗非班(欣维宁)组 PCI 术中即刻静脉予负荷量0.4μg/kg·min^(-1)×30 min,维持量0.15μg/kg·min^(-1)×36 h。两组患者 PCI 术中均给予肝素8 000～10 000 U。PCI术前服用氯吡格雷300 mg,阿司匹林300 mg,术后各75 mg/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。结果盐酸替罗非班组 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。出血并发症的发生率高于对照组,差异无统计学意义。结论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 in patients with acute ST elevation myocardial infarction（STEMT） treated by primary percutaneous coronary intervention（PCI）. Methods 58 STEMT patients were randomly divided into two groups： 30 patients in tirofiban group and 28 in control group. All the individuals were performed PCI with 12 hours after onset of AMI. Immediately after PCI, all the individuals of tirofiban group were intravenously administered tirofiban（0. 15 ug/kg · min ^-1 ） following a loading dose in 30 mins （0. 4 ug/kg · min^-1 ）. All the individuals were intravenously administered heparin 8 000 - 10 000 u during PCI and ciopidogrel 75 mg perday and aspirin 75 mg per day after PCI. Thrombolysis in acute myocardial infarction（TIMI） grade was studied before and after PCI. The major adverse cardiac events（MACE） in 4 weeks and bleeding complications were studied . Results In tirofiban group, the occurrence of slow-reflow and MACE at 4 weeks were significantly lower than those in control group. The occurance of bleeding complication in tirofiban group was higher than those in control group, hut there was no significant difference in both groups. Conclusion Application of tirofiban during primary PCI in patients with AMI was safe and effective, which may reduce the occurrence of MACE and improve TIMI flow of the infarction related artery（IRA） in patients with AMI during primary PCI.