冠脉内应用替罗非班对STEMI急诊PCI术后心肌灌注的影响

Comparison with the Effect of Tirofiban on Improving Myocardium Reperfusion in Patients with Acute ST-Segment Elevation Myocardial Infarction after Percutaneous Coronary Intervention by Different Routes

目的比较急性ST段抬高性心肌梗死(STEMI)患者急诊冠脉介入治疗(PCI)术前静脉应用和术中冠脉内应用替罗非班对PCI术后心肌组织灌注的影响。方法 2005年5月-2010年6月,共计116例接受急诊PCI的STEMI患者,随机分为两组:替罗非班术前静脉应用组(静脉组,n=58)和术中冠脉内应用组(冠脉组,n=58)。两组患者均在PCI前后常规给予抗血小板药物口服、肌肉注射低分子肝素。比较两组基础临床情况,术后即刻观察疗效,出血事件及应用术前术后ST段回落率、TIMI血流分级、校正的TIMI(CTFC)、2周后室壁运动记分(WMSI)等指标,比较两组疗效。结果冠脉组患者治疗后ST段完全回落率(≥70%)、TIMI血流分级(TIMI 3级快血流)、校正的TIMI帧数明显优于静脉组(P<0.05)。随访2周,两组患者WMSI、EF均改善,但冠脉组较静脉组改善更多(P<0.05)。两组术后出血并发症发生率无统计学意义。冠脉内应用替罗非班在改善冠脉介入术后心肌组织灌注水平上优于静脉内给药。结论在阿司匹林和氯比格雷、低分子肝素基础上,PCI术中冠脉内应用替罗非班较静脉内应用可更加改善STEMI患者术后即刻和术后2周心肌组织灌注疗效,而出血并发症未增加。

Objective To investigate the effect of tirofiban on improving myocardium reperfusion in patients with acute ST-segment elevation myocardial infarction after primary percutaneous coronary intervention （PCI） by two different routes：intravenous or coronary injection. Methods A total of 116 patients with ST-elevation acute myocardial infarction,who underwent primry PCI, were randomized into two groups. Fifty-eight patients in groups A were treated with tirofiban by coronay injection （ 10 μg/kg bolus≥ 3 min ,0.15 μg/kg. min infusion for 24 h）. Fifty-eight patients in groups B were treated with tirofiban by intravenous injection [ 0.15 ≥g/（ kg · min） infusion for 24 h ]. All patients received antiplatelet preparation and intravenous heparin;the change of TIMI blood flow, corrected TIMI flame count （ CTFC ） , degree of ST-segment recovey, ventricular wall motion score index （ WMSI）, rate of bleeding complication were compared between two groups. Results TIMI 3 fast-bloodflow, CTFC, degree of ST- segment fully-recovery after trearnent in group A were significant superior to group B（ P 〈 0.05 ）. the WMSI and EF significantly improved at half month in both groups, but the A WMSI in gnoup A were significantly higher than that in group B （ P 〈 O. 05 ）. There was no increase of bleeding complication in group A. Conclusion Application of tirofiban by coronary injection can decrease the probability of no-flow and slow-flow phenomenon, and improve myocardial tissue reperfusion and the prognosis remarkably.