经皮腔内冠状动脉介入术前应用替罗非班治疗急性冠脉综合征的疗效观察

Clinical efficacy of preoperative application of hydrochloride tirofiban in patients with acute coronary syn- drome by percutaneous coronary intervention

目的观察经皮腔内冠状动脉介入术（PCI）前给予替罗非班治疗急性冠脉综合征（ACS）的临床疗效和应用价值。方法60例行PIC手术的ACS患者随机分为观察组和对照组，观察组在常规治疗的基础上，于急诊PCI前1h给予盐酸替罗非班治疗，对照组仅给予常规治疗。观察两组住院期间出血和血小板减少症发生情况，比较两组术前和术后1个月心功能改善情况，记录术后1个月不良心血管事件。结果观察组出血率（6．7％）显著低于对照组（23．3％）（χ2=15．594，P〈0．01），血小板减少症发生率（3．3％）显著低于对照组（10．0％）（χ2=13．366，P〈0．01）。两组治疗后左室射血分数、心输出量、E峰A峰比显著上升，与治疗前差异均有统计学意义（均P〈0．05）；且治疗组与对照组差异均有统计学意义（均P〈0．05）。治疗组不良心血管事件发生率为33．3％（10／30），对照组为66．7％（20／30），差异有统计学意义（χ2=8．924，P〈0．01）。结论替罗非班是一种安全、有效的抗血小板药物，对于介入治疗的ACS患者，术前使用替罗非班可以降低心血管事件的发生。

Objective To observe the clinical efficacy and application value of preoperative application of hydroehloride tirofiban in patients with acute coronary syndrome（ACS） by percutaneous coronary intervention（PCI）. Methods 60 ACS patients underwent PIC surgery were randomly divided into observation group and control group. All patients underwent preoperative and postoperative regular routine anti-angina and acute myocardial infarction treat- ment, the observation group was given the hydrochloride tirofiban in 1 h before surgery of emergency PCI, the control group received conventional therapy. The bleeding and thromboeytopenia occurrence during hospitalization of the two groups were observed, before surgery and 1 month after surgery the cardiac function of the two groups were compared, 1 month after surgery the occurrence of adverse cardiovascular events were recorded. Results The bleeding incidence of observation group was 6.7%, the control group was 23.3%, the difference between two groups was significant （ χ2 = 15. 594, P 〈 0.01 ） ; The thrombocytopenia occurrence of observation group was 3.3%, the control group was 10.0% ,the difference between two groups was significant（ χ2 = 13. 366 ,P 〈0.01 ）. 1 month after surgery the LVEF, CO and E/A of the two groups increased significantly, compared with the prior-treatment, the difference was significant （ P 〈 0. 05 ） , and the difference was significant between the two groups （ P 〈 0.05 ） ; The occurrence of adverse cardio- vascular events of observation group was 33.3%, the control group was 66.7%, the difference between two groups was significant（χ2= 8. 924, P 〈 0.01 ）. Conclusion The hydrochloride tirofiban is a safe and effective anti-platelet drugs. Preoperative application of hydrochloride tirofiban in patients with ACS by PCI can reduce the occurrence of cardiovascular events.