替罗非班对糖尿病并ST段抬高急性心肌梗死急诊PCI术后心肌灌注的影响

Effect of tirofiban on the myocardial perfusion during primary percutaneous coronary artery interventional therapy in patients with diabetes mellitus accompanied with acute ST elevation myocardial infarction

目的:探讨急诊经皮冠状动脉介入治疗(PCI)术应用国产替罗非班对糖尿病(DM)并ST段抬高急性心肌梗死(STEMI)患者心肌灌注的影响。方法:79例首发STEMI且有DM并接受急诊PCI治疗的患者,随机分为替罗非班组(n=38)和常规治疗组(n=41),替罗非班组患者诊断后即刻给予替罗非班氯化钠注射液10μg.kg-1于3 min内推注完毕,术后替罗非班0.15μg.kg-1.min-1滴注24～36 h,其余治疗同常规治疗组。比较两组患者心肌灌注分级(TMPG)、测定两组术后肌酸激酶(CK)及心肌型肌酸激酶同工酶(CK-MB)峰值水平和出血并发症。结果:两组基础临床情况和造影特征无明显差异。替罗非班组心肌灌注良好获得率明显增高;替罗非班组术后CK及CK-MB峰值水平明显减低;替罗非班组轻度出血发生率有高于对照组趋势,但无严重出血或血小板减少症。结论:国产替罗非班能改善DM并STEMI患者心肌灌注指标,减少心肌损伤,不增加出血及血小板减少症并发症的发生率。

Objective： To evaluate the effect of the glycoprotein IIb/IIIa receptor blocker tirofiban on myocardial perfusion during primary percutaneous coronary artery interventional therapy （PCI） in patients with diabetes mellitus accompanied with acute ST elevation myocardial infarction. Methods： Totally 79 patients with ST elevation myocardial infarction accompanied with diabetes mellitus admitted in our hospital received PCI. They were divided into tirofiban （n = 38） and control （n = 41, conventional treatment alone） groups according to the use of tirofiban in the operation. Patients in tirofiban group were administered with tirofiban （10 μg·kg-1, iv bolus） within 3 min after the diagnosis, and tirofiban （0.15 μg·kg-1·min-1 intravenous drip） was maintained for 24 -36 h after PCI in addition to conventional treatment. In all the patients, the indices of TIMI myocardial perfusion grade （TMPG） and the levels of plasma CK, CK-MB were determined, and the rates of bleeding complications were evaluated. Results ： Clinical baseline before treatment was similar in two groups. The rate of the myocardial perfusion was high- er, and the peak levels of plasma CK, CK-MB were lower in tirofiban group than in control group. The rate of minor bleeding complications was higher in tirofiban group than in control group, but there was no significant difference. No patient had major bleeding or thrombocytopenia. Conclusion： Application of tirofiban during primary PCI can improve myocardial perfusion, reduce myocardial damage, and not increase the incidence of bleeding complications or thrombocytopenia in patients with diabetes mellitus accompanied with acute ST elevation myocardial infarction.