替罗非班在急性心肌梗死溶栓不同时期应用的疗效

Application of tirofiban in different periods of thrombolysis in acute myocardial infarction

目的:观察替罗非班在急性心肌梗死溶栓不同时期应用的疗效及安全性。方法:87例ST段抬高型急性心肌梗死患者随机分为常规溶栓组(30例)、早期使用替罗非班组(溶栓前给药28例)和补救替罗非班组(溶栓失败后给药29例)。采用判断溶栓再通间接指标来评估3组患者梗死相关血管的再通率;观察患者出血的发生率及24 h内并发症。结果:早期应用组血管再通率明显提高,心肌肌钙蛋白I浓度峰值、肌酸激酶同工酶浓度峰值和达峰时间与常规溶栓组、补救应用组比较,明显降低和缩短(P<0.05),应用替罗非班后较常规溶栓组胸痛持续时间缩短,ST段下降时间提前(P<0.05)。出血的发生率无统计学意义。在24 h内并发症方面,3组无明显统计学差异。结论:溶栓联合替罗非班,特别是早期应用者可以提高溶栓成功率,减轻心肌损害而不会增加并发症和出血风险。

AIM To assess the safety and efficacy of tirofiban in different periods of thrombolysis inacute myocardial infarction. METHODS： Eighty-seven patients with ST-segment elevation myocardialinfarction （STEMI） were randomly divided into three groups： routine thrombolysis group （thrombolysisonly, n = 30） , pretreatment tirofiban group （tirofiban before thrombolysis, n = 28） and rescue tirofibangroup （tirofiban after thrombolysis failure, n = 29 ）. The perfusion indirect indexes of thrombolysis wereobserved in the three groups. Major cardiovascular complications in 24 h and hemorrhagic events werealso observed. RESULTS： Rapid reperfusion was observed in the pretreatment tirofiban group. Peakvalue and peak time of cardiac troponin I （cTNI）, ereatinine kinase and MB isoenzyme （CK-MB） in thepretreatment tirofiban group were lower and shorter than those in the routine thrombolysis group and rescue tirofiban group. Administration of tirofiban before or after thrombolysis more effectively shortened theduration of chest pain and lessened the ST segment descent compared with those in the routine thrombolysis group. But no signifcant difference was found in hemorrhage events and cardiovascular complicationsduring 24 h among the three groups. CONLUSION： Tirofiban combined with thrombolysis, especiallyadministration of tirofiban before thrombolysis, could improve the success rate of thrombolysis and lessenthe myocardial injury without increasing cardiovascular complications and hemorrhage risks.