半剂量替罗非班治疗老年高危不稳定型心绞痛疗效观察

Therapeutic effects of half dose tirofiban in the treatment of aged high-risk patients with unstable angina pectoris

目的评价半剂量的替罗非班治疗老年高危不稳定型心绞痛的临床疗效及安全性。方法 142例老年不稳定型心绞痛患者随机分为常规治疗组(47例)、半剂量组(47例)和常规剂量组(48例),半剂量组在常规治疗组标准化治疗的基础上加用替罗非班,先给予负荷量(0.2μg·kg-1·min-1),0.5h后再以0.05μg·kg-1·min-1维持量维持48h;常规剂量组在常规治疗组标准化治疗的基础给予负荷量(0.4μg·kg-1·min-1)替罗非班0.5h后以0.1μg·kg-1·min-1维持量维持48h。观察治疗时心绞痛发作频率、程度、持续时间、硝酸甘油用量、18导联静息心电图变化以及出血事件。结果心绞痛症状总有效率:半剂量组91.49%、常规剂量组95.83%、常规治疗组76.60%,常规剂量组和半剂量组的有效率均显著高于常规治疗组(P=0.006,P=0.049)。但常规剂量组和半剂量组的有效率比较差异无统计学意义(P=0.384)。心电图疗效:经过治疗后三组患者心电图下移较治疗前均有显著性改变(P<0.01)。出血事件发生率比较:半剂量组4.26%、常规剂量组18.75%、常规治疗组2.13%,常规剂量组出血事件发生率较半剂量组和常规治疗组显著增加(P=0.027,P=0.021)。半剂量组和常规治疗组两组出血事件发生率差异无统计学意义(P>0.05)。结论应用半剂量的替罗非班治疗治疗老年高危不稳定型心绞痛,能有效缓解心绞痛症状和改善心电图,其不良反应较常规剂量组显著减少。

Objective To evaluate therapeutic effects and safety of half dose tirofiban in the treatment of aged high-risk patients with unstable angina pectoris. Methods A total of 142 aged high-risk patients with unstable angina pectoris were randomly divided into half dose group （n=47）, routine dose group （n=48） and routine treatment group （a=47）. Half dose group was treated by tirofiban based on standard treatment for routine treatment group, loading 0.2 μg/（kg. rain）, 30-minute intravenous infusion, followed by maintenance dose 0.05 μg/（kg. min） 48-hour continuous intravenous infusion. Routine dose group was treated by tirofiban based on standard treatment for routine treatment group, loading 0.4 μg/（kg ·min）, 30-minute intravenous infusion, followed by maintenance dose 0.1 μg/（kg. rain） 48-hour continuous intravenous infusion. The frequency of angina, degree, duration, nitroglycerin consumption, 18-lead ECG changes and bleeding events were observed. Results The total effective rate for symptoms of angina pectoris was 91.49 % in half dose group, 95.83% in routine dose group, 82.98% in routine treatment group. The total effective rate was significantly higher in half dose group and routine dose group than routine treatment group （P=0.006; P=049）, but showed no statistically significant difference between half dose group and routine dose group （P=0.384）. There is a significant difference of improvement on ECG of the three groups before and after treatment （P〈0.01）. The incidence of hemorrhage was 4.25% in half dose group, 18.75% in routine dose group, 2.13% in routine treatment group. There is a significant difference in incidence of hemorrhage between half dose group and routine dose group （P=-0.027; P=-0.021）, but there was no statistical difference between half dose group and routine treatment group （P〉 0.05）. Conclusion Half maintenance doses oftirofiban is safe and effective in improving symptoms of angina pectoris and electrocardiogram in aged high-risk patients with unstable angina pectoris. Hyporhea in half dose group is significantly decreased than that of routine dose group.