小剂量替罗非班治疗高龄非ST段抬高急性冠状动脉综合征患者的疗效及安全性

Clinical Efficacy and Safety of Low Dose of Tirofiban in Elderly Patients with Non ST ElevationAcute Coronary Syndrome

目的观察小剂量替罗非班治疗高龄非ST段抬高急性冠状动脉综合征(NSTEACS)患者的疗效及安全性。方法入选92例NSTEACS患者,年龄均>75岁(75～84岁),其中不稳定心绞痛58例,急性非ST段抬高心肌梗死34例。将入选患者随机分为两组:对照组44例,采用常规量阿司匹林、氯吡格雷及低分子肝素治疗;治疗组48例,除上述治疗外,加用国产替罗非班,按说明书提供的剂量减半给药,即0.2μg/(kg·min)静脉滴注30min后改为0.05μg/(kg·min)连续静脉滴注48～72h。观察住院期间主要不良心脏事件(任何原因的死亡、再发心肌梗死、急性左心衰竭)发生率、心绞痛缓解情况、心电图ST段变化及出血情况。结果治疗组心血管事件发生率明显低于对照组(P<0.05);治疗组心绞痛缓解总有效率(93.8%)高于对照组(77.3%)(P<0.05);两组治疗后心电图ST段下移程度及缺血导联数量均改善(P<0.05),治疗组优于对照组(P<0.05);两组均无严重出血发生。结论小剂量替罗非班对高龄NSTEMI患者有良好的疗效及安全性。

Objective To investigate the efficacy and safety of low dose of tirofiban in elderly patients with non ST elevation acute coronary syndrome（NSTEACS）.Methods 92 elderly patients（75～84years old） with NSTEMI（58 unstable angina,34 non ST elevation acute myocardio infarction）were enrolled and divided into two groups.44 patients in control group were given routine treatments,including asprin,clopidogrel and heparin by conventional dose,while 48 patients in treatment group were given intravenous drip of tirofiban in a dose of 0.2μg/（kg.min） for 30 min,then given continuous intravenous drip in a dose of 0.05μg/（kg.min）（half dose of that provided in the instructions）for 48 to72 hours beyond routine treatments.Main acute cardic event（death for any reason,new myocardial infarction and acute heart failure）,remission of angina,change of ST segment and bleeding were observed within hospitalization.Results Main acute cardic event was lower in treatment group than that in control group（P0.05）.The total effective rate of angina remision was higher in treatment group（93.8%） than that in control group（77.3%）（P0.05）.The decline of ST segment and reduction of number of ischemic lead occurred in two groups after treatment（P0.05）,but treatment group was prior to control group（P0.05）.None severe bleeding presented in two groups.Conclusions Low dose of tirofiban is a safe drug with a good effect to elderly patients with NSTEACS.