冠状动脉内应用替罗非班对急诊介入治疗急性心肌梗死患者心肌灌注的影响

Effect of intracoronary tirofiban on myocardial reperfusion in patients with STEMI undergoing percutaneous coronary intervention

目的探讨急诊冠脉介入治疗(PCI)术中冠脉内应用替罗非班对急性心肌梗死(AMI)患者冠脉血流的影响。方法接受急诊PCI治疗的急性ST段抬高型心肌梗死(STEMI)患者114例随机分为替罗非班组及对照组。替罗非班组(n=58)冠状动脉内注射替罗非班10μg/kg,继之以0.075 ug/(kg.min)静脉滴注24～48 h,对照组(n=56)不应用替罗非班。比较两组患者PCI术后90 min心电图ST段回落百分比(sum STR),根据冠状动脉造影图像观察两组患者TIMI血流分级情况。结果替罗非班组TIMI3级血流比例显著高于对照组,差异有统计学意义(77.6%比48.2%,P<0.01)。替罗非班组ST段回落程度明显优于对照组,差异有统计学意义(P<0.05)。结论急诊PCI的STEMI患者冠脉内注射替罗非班可显著改善靶血管前向血流TIMI分级,增加心肌组织灌注。

Objective To explore the effect of intracoronary tirofiban on myocardial reperfusion in patients with acute myocardial infarction （ AMI ）undergoing emergency percutaneous coronary intervention （ PCI ）. Methods 114 patients with AMI treated by emer- gency percutaneous coronary intervention （PCI ） were selected and divided randomly into tirofiban group and control group, tirofiban group （ n = 58,10 p,g/kg bolus followed by 0. 075 μg/（ kg · min ） infusion fou 24 to 48 hours ） , control group （ n = 56, no tirofihan ）. The resolution of the sum of ST-segment elevation （ sum STR） 90 minutes after the procedure was compared between the two groups. Thrombolysis in myocardial infarction （TIMI） flow grade was assessed from coronary angiography picture at the end of PCI. Result Compared with control group, TIMI3 flow degree of tirofiban group in the last coronary angiography picture after PCI was significantly higher （77. 6% vs 48.2% ,P 〈 0. 01 ）. The sum STR in tirofiban group at 90 minutes after the procedure was higher than control group （ P 〈 0.05 ）. Conclusion Intracoronary injections of tirofiban to STEMI patients during emergency PCI could improve acoronary arteri- al blood flow and myocardial tissue perfusion.