替罗非班在老年STEMI患者PCI治疗中的作用

Efficacy of tirofiban in elderly patients with ST-segment elevation acute myocardial infarction treated with percutaneous coronary intervention(PCI)

目的：观察小剂量替罗非班在老年急性ST段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入（PCI）术中的治疗效果，并探讨其临床安全性。方法选取急性STEMI并行急诊PCI治疗的老年患者150例，使用随机数字表法分为替罗非班组（80例）和对照组（70例），两组患者术前均予以阿司匹林300mg及氯吡格雷300mg顿服，术后长期服用阿司匹林100mg、氯吡格雷75mg，1次/d，替罗非班组在常规治疗基础上给予替罗非班负荷量（5μg/kg）在3min内静脉推注后以0.075μg/（kg·min）静脉滴注维持24h。观察两组手术前后梗死相关动脉TIMI血流情况、术后心电图相关导联抬高的ST段回落幅度、住院期间出血及继发血小板减少症等事件发生率、术后3个月左心室射血分数（LVEF）及主要不良心血管事件（MACE）发生情况。结果 PCI术后，替罗非班组TIMI血流2-3级者75例（93.75%），ST段回落幅度为（69.96±15.53）%，均显著高于对照组的58例（82.86%）和（64.18±14.02）%，差异均有统计学意义（均P＜0.05）；住院期间替罗非班组出血事件发生6例（7.5%），低于对照组（P＜0.05），而血小板减少情况未见明显增多（P＞0.05）。3个月随访结果显示，替罗非班组LVEF改善情况显著优于对照组（P＜0.01），而MACE发生率则降低（P＜0.05）。结论小剂量替罗非班能有效提高老年急性STEMI患者PCI术后冠状动脉血流灌注，且不增加出血及血小板减少的风险，同时可改善心功能、降低MACE的发生。

Objective To evaluate the efficacy and safety of low dose tirofiban in elderly patients with ST- segment eleva-tion acute myocardial infarction （STEMI） treated with primary percutaneous coronary intervention （PCI）. Methods One hundred and fifty elderly patients with STEMI treated with PCI during August 2011 and January 2014 were randomly divided into tirofiban group （n=80） and control group （n=70）. Two groups received preoperative medication with aspirin 300mg, clopidogrel 300mg once oral y , and postoperative medication with aspirin 100mg, clopidogrel 75mg, both once daily, while the patients in tirofiban group were administered intravenously with a bolus dose of 5μg/kg within 3 min and fol owed by continuous intravenous infusion at a dose of 0.075μg/ （kg·min） for 24h in addition to conventional treatment. The TIMI grade flow of infarct- related artery before and after PCI and postoperative electrocardiogram ST- segment index were assessed. During hospitalization the incidences of the bleeding complications and secondary thrombocytopenia were recorded. The left ventricular ejection fraction （LVEF） and ma-jor adverse cardiac events （MACE） rates at 3 month after PCI operation were observed. Results There was no significant differ-ence in preoperative PCI infarct- related factors between control group and tirofiban group （P〈0.05）. In the tirofiban group, there were 75 patients with TIMI grade 2-3 （82.86%）, and the decline degree of ST- segment after operation was （64.18±14.02）%, which was significantly higher than that in control group （P〈0.05）. The hemorrhage events occurred in 6 cases （7.5%） of tirofiban group, which was significantly lower than that in control group （P〈0.05）, while there was no significant difference in hrombocy-topenia between two groups （P〈0.05）. After fol ow up for 3 month, LVEF was significantly higher （P〈0.05） and the incidence of MACE was significantly lower （P〈0.05） in tirofiban group than those in control group. Conclusion Low dose tirofiban for elderly patients with STEMI can effectively improve the blood stream of coronary artery after PCI ameliorate cardiac function and de-crease the occurrence of MACE, while not increase the risks of bleeding and thrombocytopenia.