早期应用替罗非班对高危非ST段抬高急性冠脉综合征患者介入治疗术后心肌灌注和心肌损伤的影响

The Effect of Tirofiban Early Used on Myocardial Perfusion and Injury in the Patients Diagnosed High Risk NSTE-ACS Who Accepted Percutaneous Coronary Intervention.

目的探讨早期应用替罗非班对高危非ST段抬高急性冠脉综合征(NSTE-ACS)介入治疗术后心肌灌注和心肌损伤的影响。方法 96例高危NSTE-ACS患者,随机分为早期组和常规组各48例,早期组于入院后即刻使用替罗非班;常规组于冠脉造影结束后开始使用替罗非班,两组均于入院48h内完成经皮冠状动脉介入治疗(PC I)。比较两组PC I术前术后心肌灌注分级(TMPG);PC I术前和术后6h、12h心肌标志物肌钙蛋白I(cTnI)比例及水平;住院期间及术后30天主要不良事件、出血及血小板减少症发生率。结果两组患者的临床资料无统计学差异(P>0.05);冠脉造影结果示罪犯血管部位、狭窄程度、血流达TMPGⅡ、Ⅲ级比例无差异(P>0.05);两组PC I术均获成功,早期组PC I术后TMPGⅡ、Ⅲ级比例明显高于常规组(P<0.05);早期组术后6h、12h cTnI升高比例及水平低于常规组(P<0.05);两组在住院期间及术后30天的主要事件发生率、出血及血小板减少症发生率无差异(P>0.05)。结论在早期介入治疗的高危NSTE-ACS患者中早期应用替罗非班,明显改善心肌灌注,减少心肌损伤,不增加出血及血小板减少症并发症发生率。

Objective To investigate the effects of tirofiban earliy used on myocardial perfusion and myocardial injury in the patients diagnosed as high risk non -ST -elevation myocardial infarction （NSTE -ACS）, who had accepted pereutaneous coronary intervention. Methods Ninety- six patients diagnosed as non- ST- elevation acute myocardial infarction were divided randomly into two groups：the early group and the regularly group. Patients in the early group were given the tirofiban immediately after the admission, and the patients in the regular group were given the tirofiban after the coronary angiography. All of the patients were accepted percutaneous coronary intervention（PCI） in forty - eight hours after the admission. The myocardial perfusion grading（TMPG） of preoperative and postoperative between the two groups was compared. At the same time, we compared the level and upgrade ratio of troponin I （ cTnI）, analyzed at different times, as the preoperative, six hours after operation and twelve hours after operation. At last, we compared the adverse events hemorrhage, and thromboeytopenia in thirty days after onste in different groups. Results There was no statistical significaee on the clinical data between the two group（ P 〉 0.05 ）. The results of the coronary angiography showed no statistical significamee between the two groups on the criminal vascular position, degree of stenosis and the ratio of bloodstream reached TMPG Ⅱ or TMPG （ P 〉 0.05 ）. Patients in both group had accepted PCI successfully. The ratio of patients achieved TMPG Ⅱ or TMPG Ⅲ after PCI was significant higher that in the early group（P 〈0.05）. The level and upgrade ratios of cTnI analyzed at the preoperative, six hours after operation and twelve hours after operation was decreased obviously in the early group （ P 〈 o. 05 ）. The adverse - events, hemorrhage, and thrombocytopenia in thirty days after onste in different groups were without predominance distinction. Condusion Tirofiban in the high - risk NSTE - ACS patients who accepted PCI earlier can improve myocardial perfusion significantly. The tirofiban can decrease the myocardial injury at the same time, but the complications such as hemorrhage and thrombocytopenia didn＇ t increase obviously.