替罗非班在ST段抬高心肌梗死急诊PCI疗效观察

Observation of Pre-Angiography Use of Tirofiban in Patients with Acute ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

目的探讨在急性ST段抬高心肌梗死(STEMI)患者早期应用替罗非班对行经皮冠脉介入治疗术前、术中相关血管(IRA)再通率的疗效,术后心血管事件的发生率及PCI术后出血等并发症的发生率。方法选择2009年2月-2010年2月共85例在医院行急诊冠状动脉造影+经皮冠状动脉腔内介入术(CAG+PCI)的患者,其中男性52例,女性33例,将患者随机分为两组,A组为替罗非班组:共45例,于行PCI术前至少40 min使用替罗非班;B组为常规治疗组:共40例,术前未使用替罗非班,常规内科常规、抗凝、抗血小板等治疗,通过观察患者于冠脉造影术中显示病变相关血管(IRA)前向血流、PCI术中慢血流或无复流现象、术后出血并发症及近期心血管事件发生率,采用SPSS统计软件包,采用χ2检验。结果所有患者均成功行PCI术,两组患者行急诊冠脉造影结果显示病变相关血管(IRA)远端血流TIMI 2～3级出现率,A组患者明显高于B组患者,差异存在统计学意义(P<0.05)。术中出现慢血流或无复流现象和术中及术后两组患者出血及近期严重心血管事件发生率两者差异均无统计学意义。结论急性ST段抬高心肌梗死于行急诊PCI术前早期使用替罗非班,能有效促进闭塞血管术前血流的再通,改善相关血管的前向血流,有助于提高急诊PCI的判断及成功率,而出血等并发症及近期心血管事件并没有增加。

Objective To study the efficacy of recanalization rate of early tirofiban use in patients with acute ST segment elevation myocardial infarction pre-operative and operative, and the incidence of complication such as post-operative bleeding and cardial events post-operative. Methods 85 patients who received the emergent CAG and PCI in our hospital from February 2009 to February 2010 were randomly divided into 2 groups ：tirofiban group（45 cases） ,which was used Tirofiban at least 40 min before PCI,conventional treatment group （40 cases） ,which was treated with anti-coagulation and anti-platelet treatment. In order to observe the efficacy, the IRA forward flow, slow flow and no-reflow, the complications after-PCI were observed and analyzed with the SPSS statistical package. Results All the PCI was successful. IRA and the occurrence rate of flow TIMI 2 N 3 in tirofiban group were significantly higher that those in conventional treatment group. The difference of IRA forward flow, slow flow and no-reflow, the complications after-PCI between the two groups were not significant. Conclusion Early tirofiban can efficiently promote the recanalization rate of no-operative occlusive vascular, improve the forward flow of IRA, promote the success rate and judgement of emergent. Cases with acute ST segment elevation cardial infarction before emergent PCI, and the complications of bleeding and recent cardial events remained the same.