术前应用替罗非班对急性心肌梗死患者急诊经皮冠状动脉介入治疗疗效的分析

Analysis of Preoperative Use of Tirofiban in Percutaneous Coronary Intervention for Patients with Acute ST-segment Elevation Myocardial Infarction

目的探讨在急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者行急诊经皮冠状动脉介入治疗(percuteous coronary intervention,PCI)时,术前静脉注射替罗非班对术后冠脉血流及近期疗效的影响。方法 93例急性STEMI患者行急诊PCI治疗,随机分为术前静脉注射替罗非班(早期组,46例)和造影后静脉注射替罗非班(晚期组,47例)两组。分析两组患者术前基础临床情况、术前梗死相关血管前向血流情况、术后冠脉TIMI血流分级、校正的TIMI血流计数帧数(corrected TIMI frame count,CTFC)、射线照射时间及造影剂用量、左心室射血分数、术后3个月主要心血管事件(major adversecardiac events,MACE)。结果两组患者基础临床情况差异无统计学意义,早期组患者术前梗死相关动脉(infarction related arter-y,IRA)前向血流达到TIMI2～3级的比例高于晚期组(分别为30%和13%,P=0.038)。两组患者术后IRA前向血流达到TIMI3级的比例、心功能、近期MACE比较差异无统计学意义,但早期组患者射线照射时间、CTFC及造影剂用量均少于晚期组,两组比较差异有统计学意义(P<0.05)。结论急性STEMI行急诊PCI时,替罗非班注射液的不同应用时间对近期的临床预后虽然没有明显改善,但术前静脉应用可以提高IRA前向血流TIMI3级的比例,减少射线照射及手术时间。不同应用方法均不增加出血发生率,临床应用安全有效。

Objective To explore the effect of preoperative use of tirofiban on coronary flow and early effect on percutaneous coro- nary intervention（PCI） in patients with acute st - segment elevation myocardial infarction （ STEMI）. Methods Totally 93 patients with STEMI were randomly divided into preoperative use of tirofiban （early group, n = 46） and post- coronary arteriongraphy use of tirofiban （late group, n = 47 ）. Based clinical characteristics and blood flow of infarction related artery （IRA） data, TIMI blood flow grade after PCI,eorrectcd TIMI frame count（CTFC） , X -ray exposure time, amount of eonstrast agent, left ventrieular ejection fraction （LVEF） , major adverse cardiac events rates（MACE） within 3 months after PCI were analyzed. Results There was no statistical significance in the clinical data between the two groups. In early group, the rate of IRA achieved TIMI2 -3 before operation was higher than the late group （30% vs 13% , P = 0. 038）. There was no statistical significance in the rate of IRA achieved TIMI3 after operation and heart function and early MACE between the two groups. X - ray exposure time and CTFC and amount of constrast agent were less than late group （P 〈 0.05）. Conclusion Though different initiation of tiroflban in patients with acute STEMI treated by PCI can not improve early clinical outcome, high rate of IRA achieved TIMI3 and less X - ray exposure time and operation time were obtained. There was no increase in the incidence of bleeding. It was a safe and effective treatment.