不同途径注射替罗非班在急性心肌梗死患者直接PCI治疗中的疗效及安全性

Effect and safety of tirofiban injected through different paths in patients with acute myocardial infarction undergoing percutaneous coronary intervention

目的比较糖蛋白(glycoprotein,GP)Ⅱb/Ⅲa受体拮抗剂(盐酸替罗非班)在急性心肌梗死患者直接经皮冠状动脉腔内介入(percutaneous coronary intervention,PCI)治疗中经冠状动脉内注射与静脉注射的疗效及安全性。方法选择98例急诊入院的急性心肌梗死行直接PCI治疗患者,分为冠状动脉内注射替罗非班治疗组(试验组)51例和静脉内注射替罗非班治疗组(对照组)47例,疗程24～36 h。记录并比较两组主要心血管事件发生率、左心室射血分数、心电图ST段回落百分比及心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血流分级。结果试验组30 d的主要心血管事件发生率与对照组比较,差异无统计学意义[3.9%(2/51)vs.6.4%(3/47),P>0.05]。试验组30 d的左心室射血分数明显高于对照组,差异有统计学意义(50%±9%vs.48%±8%,P<0.05)。试验组心电图ST段回落百分比高于对照组,差异有统计学意义(62.17%±10.14%vs.42.13%±11.76%,P<0.05)。试验组即刻TIMI血流3级患者比例高于对照组,差异有统计学意义[88.2%(45/51)vs.85.1%(40/47),P<0.05]。两组均无大出血事件发生,均未有血小板减少的患者。结论在急性心肌梗死患者直接PCI治疗中,冠状动脉内注射替罗非班能进一步减少心肌细胞的损伤,改善冠状动脉内血流,改善患者心功能,效果优于经静脉内注射途径,且安全性好,不增加大出血的发生。

Objectives To compare the effect and safety of glycoprotein （GP） IIb/IIIa receptor antagonist （tirofiban） injected through coronary artery and intravenous in patients with acute myocardial infarction undergoing percutaneous coronary intervention （PCI）. Methods A total of 98 patients with acute myocardial infarction undergoing PCI hospitalized through emergency room were enrolled in our group. There were 51 patients treated with tirofiban by coronary artery injection （test group） and 47 patients treated with tirofiban by intravenous injection （control group）. Duration of treatment was 24-36 hours. Major adverse cardiac events, left ventricular ejection fraction （LVEF）, percentages of patients with over 50% ST-fall and frequencies of thrombolysis in myocardial infarction （TIMI） grade 3 between the two groups were recorded and compared. Results The occurrence of major adverse cardiac events within 30 days had no significant difference between the two groups [3.9% （2/51） vs. 6.4% （3/47）, P〉0.05]. LVEF within 30 days in test group was significantly higher than that in control group （50%±9% vs. 48%±8%, P〈0.05）. Percentage of ST-fall in test group was significantly higher than that in control group （62.17%±10.14% vs. 42.13%±11.76% ,P〈0.05）. Frequency of instant TIMI grade 3 in test group was significantly higher than that in control group [88.2% （45/51） vs. 85.1% （40/47）, P〈0.051- There was no occurrence of severe bleeding and decrease in the number of platelets in both groups. Conclusions Intervention of tirofiban by coronary artery injection in the procedure of PCI can further decrease the damage of the cardiac muscle cells, improve the amount of blood stream in coronary artery and improve cardiac function in patients with acute myocardial infarction than by intravenous injection. The process is safe and there is no increase in the occurrence of severe bleeding.