替罗非班对急性心肌梗死患者急诊PCI术中TIMI血流的影响

Effects of Tirofiban Hydrochloride on TIMI Blood Flow in Primary Percutaneous Coronary Intervention Patients with Acute Myocardial Infarction

目的 探讨血小板膜蛋白（platelet-membrane glucoprotein, GP） Ⅱb/Ⅲa受体拮抗剂替罗非班对急性ST段抬高型心肌梗死（ST-elevation myocardial infarction, STEMI）患者急诊经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）中TIMI血流的影响.方法 将症状发生至行急诊PCI在6～12 h的STEMI患者随机分为替罗非班组（50例）和对照组（50例）,替罗非班组于术前开始静滴替罗非班,PCI时即刻冠脉内推注替罗非班5μg/kg, 继以0.15μg/（kg·min）静脉维持24～36 h.对照组常规行PCI术.记录两组基础临床情况、观察两组患者PCI手术前后TIMI血流情况及术后主要心脏不良事件（major adverse cardiac events, MACE）发生率. 结果与对照组相比,替罗非班组TIMI 2、3级血流明显增加,无复流发生率降低（P〈0.01）;替罗非班组术后12 h肌酸激酶同工酶浓度明显降低（P〈0.01）,ST段回落幅度明显增大（P〈0.01）,术后MACE发生率降低 （P〈0.05）.结论 急诊PCI时应用替罗非班治疗发病6～12 h的STEMI患者,可进一步减少无复流发生,提高心肌灌注,改善临床预后.

Objective To evaluate the effects of Tirofiban hydrochloride,the platelet GP Ⅱb/Ⅲa receptor antagonist,on the TIMI blood flow in patients with acute ST-segment elevation myocardial infarction（STEMI） undergoing primary percutaneous coronary intervention（PCI）.Methods From January 2004 to July 2010,the patients of acute STEM within 6 ~ 12h were randomly divided into Tirofiban group（n=50） and control group（n=50）.The Tirofiban group receieved intravenous Tirofiban before surgery,and intracoronary injection of Tirofiban of 5μg/kg immediately when PCI,followed by 0.15μg/（kg·min） intravenously for 24 to 36 hours.The control group underwent routine PCI surgery without Tirofiban infusion.The basis of clinical records,TIMI flow situation and the occurrence of major adverse cardiac events（MACE） during hospitalization of the two groups were observed in patients with PCI before and after the surgery.Results Compared with the control group,the incidences of grade Ⅱ and Ⅲ TIMI flow were significantly increased in the Tirofiban group（P0.01）.The incidence of no-reflow was decreased（P0.01）.The postoperative CK-MB concentration of the Tirofiban group was significantly lower than the control group（P0.01）,and the rate of MACE was lower too（P0.05）.Conclusion Combined therapy of Tirofiban with primary PCI can reduce the occurrence rate of no-reflow,and improve the myocardial reperfusion,the cardiac function and the clinical outcomes.