急性心肌梗死直接PCI术前早期应用替罗非班的有效性和安全性研究

The clinical value of early applications of Tirofiban before primary percutaneous coronary intervention in patients with acute myocardial infarction（AMI）

目的观察早期应用替罗非班在急性心肌梗死（AMI）经皮腔内冠状动脉介入治疗（PCI）中的临床价值。方法152例急性ST段抬高型心肌梗死（STEMI）行急诊PCI术患者随机分为试验组和对照组，均于发病12h内行急诊PCI术。试验组一旦确诊STEMI即静脉给予负荷量（10μg／kg）盐酸替罗非班，5min内静脉推注，继而以0．15g·kg^-1·min^-1微量泵持续泵人36h；对照组在导丝通过或球囊预扩张后在5min内静脉推注10μg／kg盐酸替罗非班，继而以0．15／μg·kg^-1·min^-1微量泵持续泵人36h。观察两组PCI术后即刻梗死相关得血管（IRA）心肌梗死溶栓（TIMI分级）血流情况和心肌灌注分级情况，术后30d内出血并发症及主要不良心脏事件（MACE）的发生情况，术后7d和30d心脏超声左室舒张末期内径（LVEDD）和左室射血分数（LVEF）。结果试验组与对照组相比，并不能改善术后冠状动脉造影血流分级，但可改善心肌灌注分级，且差异有统计学意义；术后30d，试验组的LVEDD显著小于对照组，而LVEF则显著大于对照组，且差异有统计学意义；术后30d，试验组的主要不良心脏事件发生率显著少于对照组，且差异有统计学意义；两组出血并发症发生率差异并没有统计学意义。结论在急性心肌梗死介入治疗中，早期应用盐酸替罗非班并不能改善造影血流分级，但可改善心肌灌注分级，从而保护心功能，并且是安全的。

Objective To evaluate the clinical value of early applications of Tirofiban for percutaneous coronary intervention（PCI） in patients with acute myocardial infaretion（AMI）. Methods A total of 152 AMI patients were randomly divided into test and control group. All the individuals were performed PCI within 12 hours after onset of AMI. The patients of test group were injected Tirofiban（10 p,g/kg）into vein once they were diagnosed STEMI and intravenously administered Tirofiban 36 hours （0.15 μg.kg ^-1.min^- 1） after PCI. The patients of control group were injected Tirofiban （10 μg/kg）into vein after guidewire passing through the lesion or predilation, followed by continuous infusion in 36 h （0.15 μg.kg ^-1.min^-1）. The coronary TIMI flow of IRA and myocardial perfusion grading after PC1, major adverse cardiac events（MACE ） and bleeding complications rates within 30 days were analyzed between the two groups. LVEDD and LVEF were measured at 7th day and 30th day after PCI. Results The TIMI grade was not improved by early administration with Tirofiban, but there were significant improving on myocardial perfusion grade at test group in contrast with control group. The LVEDD of test group at 30th day after PCI was less than control group, and its LVEF was better than control group. Compare to control group, test group has less MACE. There was not statistics difference on bleeding complications between two groups. Conclusion Early application of Tirofiban can safely improve myocardial perfusion grade.