早期应用替罗非班易化治疗对急性心肌梗死紧急介入治疗近期预后的影响

Effects of Facilitated Tirofiban Percutaneous Intervention on Short-term Prognosis in Patients with Acute Myocardial Infarction

目的探讨早期应用替罗非班对急性心肌梗死紧急介入治疗近期预后的影响。方法选择我院2006年1月—2009年1月收治的首发急性ST抬高心肌梗死患者共173例,根据应用替罗非班的时机将患者分为术前即刻组(G1组,介入治疗术前给药)及预先干预组(G2组,同意介入治疗后立即给药)两组,分析两组患者的基本情况、临床资料及住院期间心脏事件及出血事件。结果两组患者基线情况包括年龄、性别、高血压、糖尿病及吸烟史比较,差异均无统计学意义(P>0.05);两组患者临床情况包括:ST段抬高导联数、发病至入院时间、发病至球囊扩张时间、入院时收缩压、入院时舒张压、术前心功能分级(Killip)Ⅰ级比例、中心动脉收缩压、中心动脉舒张压、梗死相关动脉(IRA)为前降支的比例、血栓抽吸率、造影剂用量、支架植入率、药物支架使用率、支架或球囊直径、最大扩张压力(atm)、植入支架枚数比较差异未见统计学意义(P>0.05)。预先干预组应用替罗非班时间更早〔(2.96±0.76)h与(0.55±0.21)h,P<0.05〕。术前实验室检查包括入院血糖、空腹血糖、入院BUN、入院Cr、TG、TC、LDL-C、HDL-C、LDL/HDL、VLDL-C、入院时WBC、中性粒细胞分数、术后BUN、术后Cr间差异均无统计学意义(P>0.05);G2组患者肌酸激酶(CK)峰值、肌酸激酶同工酶(CK-MB)峰值较G1组明显下降〔分别为(3271±2444)U/L与(1694±1143)U/L,(315±219)U/L与(170±110)U/L,P<0.05〕。G2组与G1组患者相比,术中无再流明显减少(31.9%与19.0%,P<0.05);术后校正的TIMI帧数明显减少〔(32.1±8.2)帧与(22.7±3.1)帧,P<0.05〕;2周内LVEF(%)明显增加〔(47.5±7.4)%与(53.3±6.0)%,P<0.05〕;术后TIMI3级比例明显增加(88.4%与99.2%,P<0.05);术后ST段回落幅度明显增加〔(66.1±16.7)%与(80.9±18.4)%〕。但住院期间心脏事件、出血事件及大出血事件的发生率两组比较差异无统计学意义(P>0.05)。结论预先应用替罗非班可以改善介入术中冠脉血流灌注,减少心肌进一步损伤、保护心脏功能,且未增加住院期间出血的概率。两组患者住院期间心脏事件未能改善,可能与观察时间短有关。

Objective To investigate the effects of facilitated primary percutaneous intervention（PCI）with Tirofiban on short-term prognosis in patients with acute ST elevated myocardial infarction.Methods A total of 173 acute myocardial infarction patients were divided,based on use time of Tirofiban,into groups G1 （given Tirofiban before intervention）,G2 （immediate medication after intervention）.The baseline information,clinical data and events of heart and bleeding were analyzed.Results There was not significant difference in baseline information,clinical situations between 2 groups （P0.05）.The Tirofiban use time was earlier in G1〔（2.96±0.76）h〕than in G2〔（0.55±0.21）h〕（P0.05）.There was not significant difference in blood glucose （BG）,fasting blood glucose （FBG）,admission BUN,Cr,TG,TC,LDL-C,LDL/HDL,VLDL-C,WBC,neutrophil fraction,post-operative BUN,Cr （P0.05）.Creatine kinase （CK） peak,CK-MB peak were lower in G2 than in G1 〔（3 271±2 444）U/L vs（1 694±1 143）U/L,（315±219）U/L vs（170±110）U/L,respectively,P0.05〕,no-reflow lower （31.9% vs 19.0%,P0.05）,postoperative correction TIMI frames fewer〔（32.1±8.2）franes vs（22.7±3.1）frames,P0.05〕,2-week LVEF （%） higher 〔（47.5±7.4）% vs （53.3±6.0）%,P0.05〕,postoperative TIMI grade III flow higher （88.4% vs 99.2%,P0.05）,postoperative ST resolution rate larger〔（66.1±16.7）% vs （80.9±18.4）%〕,but there was not significant difference in cardiac and bleeding events （P0.05）.Conclusion Pretreatment use of tirofiban can improve coronary blood perfusion,reduce myocardial injury,protect heart function without increase of the probability of hospital bleeding.Unimproved hospital cardiac events may be related to short observation time.