替罗非班不同用药剂量对急性心肌梗死再灌注及疗效的影响

Effects of different doses of tirofiban on peperfusion and clinical outcomes in patients with ST-elevation myocardial infarction

目的探讨急性ST段抬高心肌梗死（STEMI）患者行急诊直接经皮冠状动脉成形术（PCI）前应用不同用药剂量替罗非班（商品名为欣维宁）对梗死相关血管（IRA）及疗效的影响。方法172例STEMI患者分为3组。A组（61例）术前只予基础用药，阿司匹林300mg、氯吡格雷300mg顿服。B组（56例）在术前基础用药上加用替罗非班300～400／μg／h静脉滴注。C组（55例）在B组用药基础上再静脉注射替罗非班10μg／kg。对3组IRA自溶率、术中无复流、ST段回落〉50％、心肌灌注分级，及住院期间临床事件（心力衰竭、大出血、死亡）进行比较分析。结果急诊冠状动脉造影发现，A、B、c组的IRA自溶率分别为31．1％、41．7％和72．7％，ST段回落〉50％构成比分别为75．4％、87．5％和94．5％，3组间的差异均有统计学意义（P值均〈0．05）。术中B、c组的无复流发生率有低于A组的趋势，但差异无统计学意义（P值均〉0．05）。3组在住院期间的心力衰竭、严重出血并发症、病死率的差异均无统计学意义（P值均〉0．05）。结论急诊PCI术前静脉滴注联合静脉注射替罗非班能显著减少STEMI患者的血栓负荷，明显升高患者IRA自溶率，减少术中无复流的发生。

Objective To investigate the effects of different doses of tirofiban on infarct-related artery （IRA） and clinical outcomes of patients with ST-elevation myocardial infarction before undergoing primary angioplasty. Methods Totally 172 patients with acute ST-segment elevation myocardial infarction were randomly divided into three groups.- A group （61 cases）, preoperative medication with aspirin 300 mg, clopidogrel 300 mg dayton suits; B group （56 cases）, intravenous infusion of tirofiban, 300- 400 tJg/h on the basis of the A group; and C group （55 cases）, intravenous bolus tirofiban 10 pg/kg the on the basis of B group. Immediate effect （selfdissolution rate of infarct vessel 1%, no reflow%, ST segment resolution% and thrombolysis in myocardial infarction [TIMI] myocardial perfusion） and clinical events during hospitalization （heart failure, hemorrhage, and death） were compared. Results Emergency angiography found that the dissolution rate （31.1% vs. 41.7% vs. 72.7%） and ST segment resolution （75. 4% vs. 87. 5% vs. 94. 5%） of the infarct-related artery were significantly different between A, B, and C groups （P d0.05）. We found that B, C groups had a lower no-reflow rate than A group （7. 1% vs. 3.6% vs. 14.8%, P = 0. 093）. The clinical events, including heart failure, hemorrhage, and death, were not significantly different between the three groups during hospitalization （P〉0.05）. Conclusion Preoperative intravenous bolus of tirofiban can significantly reduce the thrombotic burden in patients with acute ST-segment elevation myocardial infarction, greatly increasing the autolysis rate of the infarct vessel and reducing no-reflow. （Shanghai Med J, 2011, 34： 371-374）