急诊PCI术前使用血小板GPⅡb／Ⅲa受体拮抗剂预防慢血流的作用

Preventive effects of preoperative platelet glycoprotein Ⅱb/Ⅲa inhibitors on coronary slow flow during emergency percutaneous coronary interventions

目的评价急诊PCI术前应用血小板GPⅡb／Ⅲa受体拮抗剂替罗非班对预防慢血流的作用。方法选择ST段抬高型心肌梗死（STEMI）行急诊PCI术患者共128例，按单双顺序分为A、B两组。A组为治疗组，术前给予静推替罗非班并持续静滴至术后。B组为对照组，术前未使用替罗非班。观察两组慢血流情况。结果两组患者均完成急诊PCI术，其中B组1例急性广泛前壁心肌梗死合并心源性休克患者术后1天死亡，其余127例康复出院。两组均有慢血流或无复流出现。其中A组4例，3例发生在右冠脉，1例发生在前降支；B组为12例，右冠脉7例，前降支4例，回旋支1例。两组出现慢血流的例数差异有统计学意义（P〈0．05）。结论急诊PCI术前应用血小板GPⅡb／Ⅲa受体拮抗剂对慢血流的形成有一定的预防作用。

Objective To investigate the preventive effects of preoperative platelet glycoprotein Ⅱb/Ⅲa inhibitors on coronary slow flow during emergency percutaneous coronary interventions （PCI） in patients with ST elevation myocardial infarction （STEMI）. Methods 128 consecutive patients with STEMI undergoing emergency PCI were divided by odd and even order into test group and control group with 64 cases each： patients in test group were treated with additional tirofiban for 24 to 36 hours once STEMI were confirmed before PCI, but the pa- tients in control group were not treated with tirofiban. The compare the coronary slow flow phenomenon between the two groups was compared. Results All cases had finished emergency PCI. One case in control group died of acute extensive anterior myocardial infarction with cardiogenic shock at 1 day later after PCI. The remaining 127 cases discharged alive. Coronary slow flow or no-reflow occurred in both groups. Test group developed slow flow in 4 cases. In control group, however, there were 12 cases of slow flow developed. There was statistical difference in slow flow phenomenon between the two groups （P〈0.05）. Conclusion Preoperative platelet glycoprotein Ⅱb/Ⅲa inhibitors is effective in preventing slow flow during emergency PCI in patients with STEMI.