低剂量替罗非班对早期非介入治疗急性冠脉综合征患者的临床观察

Clinical Observation on the Efficacy of Low-dose Tirofiban in the Early Non-invasive Treatment of Patients with Acute Coronary Syndrome

目的观察替罗非班治疗早期非介入治疗的急性冠状动脉综合征的疗效及安全性。方法根据是否同意应用替罗非班分为治疗组和对照组98例，两组均应用阿司匹林、氯吡格雷、低分子肝素及抗缺血药物，治疗组在此基础上加用替罗非班治疗，替罗非班以负荷量0．4μg,／（kg·min），30min内微量泵泵入，继以维持量0．1μg／（kg·min）微量泵泵人48～72h。观察两组用药前后、2周时心绞痛发作情况、主要不良心脏事件，心电图、血小板、凝血功能（APTT）、肌钙蛋白T及主要出血不良反应。结果与对照组比较，治疗组在心绞痛症状缓解、心电图ST—T改变方面有明显改善，临床总有效率（87．75％）与对照组（71．43％）比较，差异有统计学意义（P〈0．05），主要不良心脏事件发生率降低，差异有统计学意义（P〈0．05），两组治疗前后及两组治疗后比较血小板数目未见明显变化（P〈0．05）。治疗组治疗48h后较治疗前、治疗2周后及对照组Am均延长，差异有统计学意义（P〈0．01）。治疗48h后治疗组肌钙蛋白T较对照组明显降低，差异有统计学意义（P〈0．05），在出血等不良反应方面两组间无明显差异。结论低剂量替罗非班是治疗急性冠脉综合症有效安全的药物。

Objective To observe the efficacy and safety of tirofiban in the early non-invasive treatment of patients with acute coronary syndrome. Methods 98 patients with acute coronary syndrome were divided into treatment group and control group ac- cording to whether the patients agreed to use tirofiban. Aspirin, clopidogrel, low molecular weight heparin and anti-ischemic drug were given to both groups. In addition, tirofiban was given to the treatment group： tirofiban with the load-dose of 0.4 μg/（kg· min） was infused by micro pump in 30 min, followed by the maintenance dose of 0.1 μg/（kg·min） infused by micro pump in 48 -72 h. The frequency of the attack of angina pectoris, major adverse cardiac events, electrocardiogram, blood platelet, blood coagulation （APTT）, troponin T and major bleeding adverse reactions of the two groups were observed before and after the treatment and two weeks after the treatment. Results Compared with the control group, the treatment group improved much better in the aspects of angina symptoms and ECG ST-T changes. The treatment group＇s clinical total effective rate was 87.75%, while that of the control group was 71.43%, the difference was statistically significant（P〈0.05）. The major adverse cardiac event rate decreased, the differ- ence between the groups was statistically significant （P 〈 0.05）. Before and after the treatment in the two group and two group after treatment than the platelet count was not changed significantly（P〉0.05）. Patients in the treatment group than before treatment, after 2 weeks of treatment and control group of APTT were prolonged after 48 h. the differences were statistically significant （P 〈 0.01）. After 48 h treatment, the treatment group＇s troponin T was significantly lower than that of the control group, the difference was sta- tistically significant （P〈0.05）; There were no statistically differences in bleeding and other adverse reactions between the two groups. Conclusion Low-dose tirofiban is effective and safe for acute coronary syndrome.