双倍负荷剂量替罗非班在急性ST段抬高型心肌梗死PCI手术中的应用研究

Efficacy and safety of double loading dose tirofiban in percutaneous coronary intervention for ST-segment elevation myocardial infarction

目的观察急性心肌梗死急诊介入治疗中应用双倍负荷剂量替罗非班的有效性和安全性。方法将163例急诊行PCI的ST段抬高心肌梗死患者随机分为受试组(83例)和对照组(80例)。受试组PCI术前给予双倍负荷替罗非班,对照组PCI术前给予单倍负荷替罗非班,观察两组PCI术前、术后TIMI血流情况,术后心电图ST段回落指数,术后30 d射血分数(EF),术后30 d内主要心血管事件(心绞痛、再次心肌梗死)及出血、血小板减少症的发生情况。结果受试组与对照组PCI术前梗死相关因素比较差异均无统计学意义(P>0.05)。受试组在进行PCI手术后即刻达TIMI 3级血流比例和术后心电图ST段回落指数高于对照组,两组比较差异有统计学意义(P<0.05)。PCI手术后30 d,受试组心脏射血分数高于对照组,并且在PCI手术30 d内主要心血管事件(心绞痛、再次心肌梗死)的发生率低于对照组,两组比较差异有统计学意义(P<0.05)。两组出血及血小板减少的发生率比较差异均无统计学意义(P>0.05)。结论在急性ST段抬高型心肌梗死急诊行介入治疗时,使用双倍负荷剂量替罗非班,不仅可以改善术后TIMI血流,降低心血管事件,而且不增加出血的风险。

Objective To observe the efficacy and safety of double loading dose of tirofiban for patients with acute myocardial infarction in emergency percutaneous coronary interventional therapy （PCI）. Methods 163 patients with ST-segment elevation myocardial infarction （STEMI） underwent emergency PCI therapy were randomly divided into experimental group （ n = 83 ） and control group （ n = 80 ）. Experimental group and control group were rendered double loading dose and single loading dose of preoperative tirofiban before PCI respectively. TIMI blood flow ,postop- erative electrocardiogram ST segment index ,ejection fraction （EF） , the main clinical adverse cardiac events （MACE） including angina pectoris, recurrent myocardial infarction, and the incidence of bleeding complications and thrombocyto- penia at 30 days after operation were observed and recorded. Results There was no significant difference of preopera- tive PCI infarct-related factors between the two groups （ P 〉 0. 05 ）. The ratio of TIMI 3 level immediately after surgery and the postoperative electrocardiogram ST segment index in experimental group were higher than those of control group, there was significant difference between the two groups （P 〈 0. 05 ）. 30 days after PCI, the ejection fraction of experimental group was higher than that of control group, and the incidences of main adverse cardiac events （ angina pectoris, recurrent myocardial infarction） was lower than those of control group during 30 days of PCI, there was signif- icant difference between the two groups （ P 〈 0.05 ）. No significant difference was found between the two groups in terms of bleeding and thrombocytopenia （ P 〉 0. 05 ）. Conclusion Acute STEMI patients use double loading dose tiro- fiban in emergency PCI can not only improve postoperative blood flow,reduce cardiovascular events, but also increase the risk of bleeding.