早期应用替罗非班对急性心肌梗死患者急诊冠状动脉介入治疗术后的影响

Influence of early application of tirofiban in patients with acute myocardial infarction after emergency percutaneous coronary intervention

目的:观察早期应用替罗非班对急性心肌梗死(AMI)患者急诊PCI术后心肌灌注情况及短期疗效的影响。方法:选择接受急诊PCI的AMI患者113例,随机分为:早期替罗非班组(60例),诊断明确后立即经静脉给予替罗非班负荷剂量10μg/kg继以0.15μg.kg-1.min-1维持泵入48h;常规治疗组(53例),于冠脉造影开始时给予替罗非班,用药方法及剂量同早期替罗非班组。比较PCI术前、术后梗死相关动脉TIMI血流情况,PCI术后TIMI心肌灌注分级(TMPG),ST段回落情况,术后心功能情况,住院期间主要心脏不良事件发生率。结果:早期替罗非班组术前TIMI血流2级比例明显高于常规治疗组(13.3%比1.9%,P=0.037),术后即刻两组TIMI血流分级无显著性差异(P=0.188);术后早期替罗非班组TMPG 3级比例明显高于常规治疗组(88.3%比73.6%,P=0.034),术后2h心电图ST段回落>50%比例早期替罗非班组亦明显高于常规治疗组(78.3%比60.4%,P=0.038),术后7d两组LVEF水平及住院期间主要心脏不良事件发生率的差异无显著性(P>0.05)。结论:早期应用替罗非班可以改善TIMI血流和术后心肌灌注,并不增加住院期间主要心脏不良事件。

Objective： To observe influence of early application of tirofiban on myocardial perfusion and short-term effect in patients with acute myocardial infarction （AMI） after emergency percutaneous coronary intervention （PCI）. Methods： A total of 113 AMI patients undergoing primary PCI were randomly divided into early tirofiban group （n=60, after identified diagnosis, patients received loading dose tirofiban of 10 μg/kg intravenously, fol- lowed by tirofiban 0.15μg · kg^-1 · min^-1 continuous infusion for 48h） and routine treatment group （n = 53, re- ceived tirofiban at the beginning of coronary angiography, the method and dosage of administration were the same as early tirofiban group）. TIMI blood flow condition in infarct related artery （IRA） before and after PCI, TIMI myocardial perfusion grade （TMPG） after PCI, ST-segment resolution, cardiac function after PCI and incidence rate of major adverse cardiac events （MACE） during admission were compared between two groups. Results： Per- centage of patients with TIMI blood flow grade 2 in early tirofiban group was significantly higher than that of rou- tine treatment group （13.3% vs. 1.9%, P = 0. 037）, there was no significant difference in TIMI blood flow instant after PCI between two groups （P = 0. 188）; compared with routine treatment group after PCI, there were signifi- cant increase in percentages of patients with TMPG grade 3 （73.6% vs. 88.3%, P = 0. 034） and patients with ECG ST segment resolutionS50% 2h after PCI （60.4% vs. 78.3%, P = 0. 038） in early tirofiban group. There were nosignificant difference in LVEF and incidence rate of MACE 7d after PCI between two groups （P〈0.05）. Conclu- sion： Early application of tirofiban can improve TIMI blood flow and myocardial perfusion after PCI without in- crease in incidence rate of MACE during admission.