急诊经皮冠状动脉介入治疗围术期上游应用替罗非班的临床研究

Upstream application of tirofiban in perioperative period of percutaneous coronary intervention： a clinical study

目的：探讨急性ST段抬高型心肌梗死（STEMI）患者行急诊经皮冠状动脉介入治疗（PCI）时，术前静脉注射替罗非班的有效性和安全性。方法2011年5月至2013年4月在蚌埠医学院第二附属医院心内科住院并接受急诊PCI的60例急性STEMI患者按入院时间顺序分为术前静脉注射替罗非班（观察组，30例）和术前不用替罗非班（对照组，30例）两组。分析两组患者术前的基本情况，术前、术后梗死相关血管的前向血流、ST段回落、血清心肌标志物及出血并发症等情况。结果两组间基础临床状况比较，差异无统计学意义（P＞0.05）。术前梗死相关动脉前向血流比较，观察组与对照组间差异无统计学意义（TIMI 0-1级13 vs 15，TIMI 2级12 vs 11，TIMI 3级5 vs 4，P＞0.05），但术后即刻前向血流，观察组好于对照组，两组间比较差异有统计学意义（TIMI 0-1级0 vs 2，TIMI 2级2 vs 8，TIMI 3级28 vs 20，P＜0.05）。两组ST段回落百分比比较，差异无统计学意义[（77.32%±18.36%） vs （71.18±19.22%），P＞0.05]。观察组术后6h血清心肌标志物值低于对照组，两组间比较差异有统计学意义[肌酸激酶同工酶（CK-MB）：（118.4±55.8） vs （178.8±63.2）U/L， P＜0.05；心肌钙蛋白T（cTnT）：（2.18±0.69） vs （3.21±0.46）ng/L，P＜0.05]。术后出血并发症比较，两组间差异无统计学意义（10.00%vs 6.67%，P＞0.05）。结论急诊PCI治疗急性STEMI时，在术前静脉应用替罗非班可以改善术后患者的心肌灌注，且不增加出血风险，临床应用安全有效。

Objective To investigate the efficiency and safety of preoperational intravenous injection of tirofiban just before performing percutaneous coronary intervention （PCI） in emergency for myocardial infarction patients with acute ST-elevation myocardial infarction （STEMI）. Methods Sixty cases with acute STEMI who were in accordance with our inclusion and exclusion criteria and received emergent PCI in our department from May 2011 to April 2013 were recruited in this study. They were prospectively divided into 2 groups by admission time, the group receiving intravenous injection of tirofiban before operation （observation group, n=30）, and the group receiving no tirofiban before operation （control group, n=30）. Basic information, forward blood flow of infarction related artery before and after operation, ST-segment resolution, serum cardiac markers and bleeding complications of the 2 groups were analyzed. Results There was no significant difference in basic clinical condition between 2 groups （P〉0.05）. The forward flow of infarct-related artery was significantly different between the 2 groups before the operation （TIMI 0-1：13 vs 15;TIMI 2：12 vs 11;and TIMI 3：5 vs 4, P〉0.05）, but after the operation, the forward blood flow was significantly better in the observation group than in the control group （TIMI 0-1： 0 vs 2; TIMI 2： 2 vs 8; and TIMI 3： 28 vs 20, P〈0.05）. No significant difference was found at the ST-segment resolution between the 2 groups [（77.32%±18.36%） vs （71.18%±19.22%）, P〉0.05]. The value of serological heart muscle markers at 6h after the operation was significantly lower in the observation group than in the control group [creatine kinase MB （CK-MB）： （118.4±55.8） vs （178.8±63.2）U/L, P〈0.05; and cardiac troponin T （cTnT）： （2.18±0.69） vs （3.21±0.46）ng/L, P〈0.05]. There was no significant difference in the bleeding complications between the 2 groups after the operation （10.00% vs 6.67%, P〉0.05）. Conclusion For emergent treatment of STEMI by performing PCI, preoperative intravenous injection of tirofiban improves postoperative myocardial perfusion, does not increase the risk of hemorrhage, and exerts great effect with sound safety in clinical application.