替罗非班和尿激酶在急诊PCI术中抗血栓作用的比较

Comparison of Antithrombotic Efficacy of Tirofiban and Urokinase during Direct PCI

目的:比较国产替罗非班和尿激酶在冠脉介入术中消除冠脉内血栓的安全性及有效性。方法:选择接受急诊冠脉介入治疗(PCI)中有较大量血栓负荷的患者20例,其中2例为溶栓失败后补救性PCI患者。经桡动脉途径行PCI,常规处理梗死相关动脉(IRA)。其中12例在PCI术中给予替罗非班10μg·kg-1的负荷量,然后给予0.15μg·kg-1.min-1的剂量持续静滴24h。另8例在30min内给予尿激酶250000U,复查造影后效果不满意者再次在30min内冠脉注入尿激酶250000U,使总量达50万U。复查造影的时间同替罗非班组。如出现皮下出血或是其他出血倾向时可减半量输入。对比两组给药1h前后的造影结果。术后常规给予抗血小板药物口服、泵入肝素500～1000U.h-1共24h,监测患者的活化部分凝血活酶时间(APTT)始终在治疗前的1.5～2.5倍,之后皮下注射低分子依诺肝素1mg·kg-1,1次.12h-1,5～7d。观察手术成功率、血栓积分、围手术期和出院3个月后患者的出血并发症及主要心脏不良事件(死亡、急性心肌梗死、紧急血运重建)的发生率。结果:替罗非班组冠脉内血栓消失的时间明显短于尿激酶组(P<0.05),两组患者的轻度出血的发生率相似,在住院期间和3个月内的随访中均无严重的心血管事件发生。替罗非班组血栓积分有显著性下降,手术成功率100%,无死亡、无再发心梗及靶血管再次血运重建。结论:在急诊PCI治疗急性心肌梗死中应用替罗非班安全有效,且替罗非班具有较强的抗血栓效果,比尿激酶具有更好的抗栓效果,而且冠脉用药和静脉用药都安全。

Objective：To evaluate the efficacy and safety of tirofiban and urokinase in patients with cornary artery disease during percutaneous coronary intervention（PCI）. Methods： A total of 12 patients with emergency coronary thrombosis during emergency PCI with 10μg/kg in 3 minutes, then was infused intravenously with 0. 15μg/kg/min for 24 hours. The urokinase group were given 500 000 iu urokinase to thrombotic coronary in 60 minutes. The major adverse cardiac events （angina,death, re-infarction of target lesion and revascularization of target lesion） and rate of bleed complications was observed before discharge and in 3 months. Results： The time than coronary blood flow reached TIMI III in tirofiban group shorter than urokinase group （P〈0.05）. PCI of patients were doing well, achievement ratio was 100%, with no angina,death,re-infarction of target lesion and revascularization of target lesion. Conclusion：The intracoronary and intravenously administration of tirofiban in patients with coronary thrombosis was safe, and more effective in removing coronary thrombus, and more effective than urokinase in removing coronary thrombi.