替罗非班联合急诊PCI对急性心肌梗死疗效观察

目的了解急性心肌梗死（AMI）行急诊经皮冠状动脉介入治疗（PCI）时，应用替罗非班改善冠状动脉血流和临床预后的疗效。方法所有确诊ST段抬高性心肌梗死（STEMI）并于发作6h内行急诊PCI手术患者80例，随机分为治疗组（A组）和控制组（B组）各40例，两组均给予急诊PCI术及氯吡格雷、阿司匹林、肝素和低分子肝素、他汀类、β受体阻滞剂等治疗，A组另给予替罗非班静脉内使用，观察两组在病变性质和术后即刻靶血管TIM／血流分级、术后心电图改变（ST段回落幅度）、术后30d内心脏不良事件（MACE）及出血事件发生率，并随访出院后MACE发生情况。结果A组PCI术后即刻靶血管TIMI血流分级明显高于B组，使用替罗非班治疗期间，A、B组出血事件及血小板减少症发生率比较，差异无统计学意义（P〉0．05），A组术后ST段回落幅度较B组明显、30d内MACE发生率明显低于B组，随访期间心血管不良事件发生率A组明显低于B组。结论在阿司匹林、氯吡格雷抗血小板治疗的基础上，ACS患者急诊PCI术中应用替罗非班比单纯PCI术及常规药物治疗，能进一步改善心肌灌注，从而改善预后。

Objective To evaluate the therapeutic effects of using tirofiban for improve coronary artery blood flow and the prognosis during treatment of emergency percataneous coronary interventional （PCI） for acute myocardial infarction （AMI）. Methods All the 80 patients who were diagnosed ST segment elevation myocardial infarction （STEMI） and had emergency PCI, they were divided randomly into treating group（ group A） and control group（ group B） with 40 in each. Both of the two groups were given emergency PCI , clopidogrel , aspirin, heparin and low molecular heparin, statin drugs and β - receptor blocker . Tirofiban was administrated intravenously in addition. The progress of the disease, the targeted vessels TIMI blood flow grade,the postoperative ECG change（ the ST segment＇s falling level） ,the major adverse cardiac events （MACE） ,the incidence rate of bleeding events and the follow - up MACE. Results The instant TIMI blood flow grade was in targeted vessels was significantly higher in group A than that in group B, there were no significant difference in bleeding events and the incidence rate of thrombopenia （ P 〉 0. 05 ）, the failing level of ST segment in A group was higher than that in B group postoperatively, the incidence rate of MACE in group A was significantly lower than that in group B within 30d and during the follow up. Conclusions Based on the treatment of antiplatelet with aspirin and clopidogrel, patients of ACS can have better myocardial perfusion and a better prognosis when using tirofiban during emergency PCI.