盐酸替罗非班在老年急性冠状动脉综合征患者中的应用

Safety and efficacy of tirofiban in elderly patients with acute coronary syndrome

目的评价老年急性冠状动脉综合征（ACS）患者应用替罗非班的有效性和安全性。方法选择2006年12月至2008年6月在苏北人民医院住院的老年ACS患者106例进行前瞻性随机对照研究，根据是否行PCI分为PCI组和药物保守治疗组，两组患者再随机分为替罗非班治疗亚组和常规治疗亚组，PCI组术前给予负荷量替罗非班10μg·kg^1-，3min内静脉注射完毕，继而以0．15μg·kg^-1·min^-1持续泵入24—36h。药物保守治疗组（负荷量0．4μg·kg^-1·min^-1×30min，维持量0．1μg·kg^-1·min^-1×48b）。采用成组t检验和方差分析法（ANOVA）分析比较各亚组问住院期间及随访30d主要心血管事件（死亡、新的心肌梗死和顽固性心肌缺血）的发生率、出血的发生率及PCI治疗组术后TIM1分级、校正的TIMI计帧数（CTFC）及心肌Blush分级（MBG）。结果各亚组间一般资料相似，药物保守治疗组中替罗非班亚组随访30dMACE发生率较常规治疗亚组显著降低（12．0％vs．36．4％；P〈0．05），PCI治疗组中替罗非班亚组CTFC低于常规治疗亚组[（23．5±5．1）帧和（31．4±5．2）帧，P〈0．01]，Blush3级获得率明显高于常规治疗亚组（64．3％和29．0％，P〈0．01）。出血发生率两组无统计学意义（P〉0．05）。结论老年ACS患者使用替罗非班具有更好的血流及心肌灌注，减少缺血事件发生，且安全性好。

Objective To evaluate the safety and efficacy of tiroiiban in gerontal patients with acute coronary syndrome（ACS）. Method A total of 106 elderly patients with ACS admitted form December 2006 to June 2008 were enrolled in a prospective case-control study. Patients were divided into percutaneous coronary intervention （PCI） group and medicine group. Both groups were randomly divided into two sub-groups, tirofiban sub-group and placebo sub-group. Patients in the PCI group received tirofiban infused in dose of 10μg· kg^- 1 within 3 minutes as loading dose before operation and then an infusion of 0.15μg·kg^- 1 min- l as maintenance dose for 24 - 36 hours. In medicine group, the loading dose was 0.4 μg·kg^- 1. min^- 1 × 30 min and the maintaining dose was 0.1 μg· kg^- 1. min^- 1 × 48 hottrs. The rates of major adverse cardiac events （MACE） consisting of death, myocardial infarction or refractory ischemia during hospital stay stay and 30 days＇ follow-up, bleeding rates TIMI grade, corrected TIMI frame count （CTFC） and myocardial blush grade（MBG） after PCI were compared between sub-groups of PCI pup. Results The basic clinical data were similar among the sub-groups. In medicine group,the MACE rate during 30 days＇ follow-up was much lower in the tirofiban sub-group than in the placebo sub-group （12.0% vs. 36.4%, P 〈 0.05）. In comparison with medicine group, in PCI group, there were fewer TIMI frames[ （23.5± 5.1） frames vs. （31.4 ± 5.2） frames, P 〈 0.01]and higher percentage of myocardial blush grade 3（64.3% vs. 29.0%, P 〈 0.01） in firofiban sub-group of PCI group. No significant differences in bleeding rates were found between all sub-groups. Conclusions Tirofiban is safe and effective in gerontal ACS patients with blood flow and repeffusion improved.