小剂量替罗非班在急性ST段抬高心肌梗死急诊PCI疗效观察

Observation of Pre-Angiography Use of Low Dose Tirofiban in Patients with Acute ST-Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

目的：探讨在急性ST段抬高心肌梗死（STEMI）患者早期应用小剂量替罗非班对行经皮冠脉介入治疗（PCI）术前、术中相关血管再通率的疗效,术后心血管事件的发生率及PCI术后出血等并发症的发生率.方法：选择2010年1月～2013年2月共84例在我院行急诊冠状动脉造影及经皮冠状动脉介入术的患者,其中男性50例,女性34例,将患者随机分为两组,观察组为替罗非班组：共44例,在行PCI术前至少50min使用小剂量替罗非班;对照组为常规治疗组（抗凝、抗血小板等治疗）：共40例,术前未使用小剂量替罗非班,常规内科治疗,通过观察患者于冠脉造影术中显示病变相关血管（IRA）前向血流、PCI术中慢血流或无复流现象,术后出血并发症及近期心血管事件发生率.采用SPSS统计软件包.结果：所有患者均成功行PCI术,两组患者行急诊冠脉造影结果显示病变相关血管远端血流TIMI 2～3级,观察组患者明显高于对照组患者,差异有显著性（P＜0.05）.术中出现慢血流或无复流现象和术中、术后出血及近期严重心血管事件发生率两者差异均无统计学意义.结论：急性ST段抬高心肌梗死行急诊PCI术前早期使用小剂量替罗非班,能有效促进闭塞血管术前血流的再通,改善相关血管的前向血流,而出血并发症及近期心血管事件并无增加.

Objective：To study the efficacy of recanalization rate of early low dose tirofiban use in patients with acute ST segment elevation myocardial infarction pre - operative and operative, and the incidence of complication such as post - operative bleeding and cardial events post - operative. Methods： 84 patients who received the emergent CAG and PCI in our hospital from January 2010 to February 2013 were randomly divided into 2 groups： low dose？ tirofiban group 44 cases, which was used low dose Tirofiban at least 50 rain before PCI, con- ventional treatment group 40 cases（which was treated with anti- coagulation and anti- platelet treatment）In order to observe the efficacy, the IRA forward flow, slow flow and no - reflow, the complications after - PCI were observed and analyzed with the SPSS statistical package. Results： All the PCI was successful. IRA and the occurrence rate of flow TIMI 2--3 in low dose tirofiban group were significantly higher that those in convention- al treatment group（P 〈 0.05 ）. The difference of IRA forward flow, slow flow and no - reflow, the complications after - PCI between the two groups were not significant. Conclusion： Early low dose tirofiban can efficiently promote the recanalization rate of no - operative occlusive vascular, improve the forward flow of IRA, Cases with acute ST segment elevation cardial infarction before emergent PCI, and the complications of bleeding and recent cardial events remained the same.