择期PCI术中应用替罗非班的疗效及其预后研究

Efficacy and outcome of Tirofiban in patients undergoing elective PCI

目的观察替罗非班在择期PCI术中的应用是否有益改善冠脉血流，促进心功能恢复，减少主要心血管不良事件的发生，以及是否增加出血性并发症。方法选取蚌埠医学院第二附属医院心内科收治的冠心病患者104例，将其分为观察组54例和对照组50例。观察组在造影后，经指引导管向冠脉内推注替罗非班15μg/kg（5min），之后以0．1μg／（min·kg）维持静脉泵入至术后36h。对照组术中不予以替罗非班应用，2组术后继续皮下注射低分子肝素5—7d，在术后12h及5d左右两次复查凝血及血细胞分析。2组患者术前及术后1周查NT-proBNP，且随访3个月。对比分析2组PCI术时TIMI血流分级、PCI术前及术后1周氮末端脑利钠肽前体（NT—proBNP）水平、3个月内主要心血管事件发生率（MACE）以及出血并发症的发生率。结果观察组在术后达TI-M13级血流情况明显好于对照组，同时无复流或慢血流发生率明显减少，2组间差异有统计学意义，P=0．005。2组患者治疗前NT—proBNP水平比较，差异无统计学意义（P〉0．05），但在PCI术后1周NT-proBNP水平均有下降，以观察组更明显，其差异有统计学意义，P=0．009。在术后3个月内的随访观察中发现：观察组患者主要心血管事件发生率更低，差异有统计学意义，P=0．042。2组的出血并发症率比较差异无统计学意义，P=0．906。结论在择期PCI术中联合应用替罗非班可改善心肌灌注，促进心功能恢复，减少主要心血管事件的发生率，并不增加出血风险，临床获益明显。

Objective To investigate the efficacy of tirofiban on thecoronary blood flow, recovery of heart function, major adverse cardiovascular events, and bleeding-related complications. Methods Total 104 cases of coronary heart disease confirmed by coronary angiography（ determined by one or more coronary artery lumen reduction of more than 50% ） in our hospital were enrolled and divided into observation group（54 cases） and control group（50 cases）. 15μg/kg（5 rain） tiro- fibanwas infused via coronary arteryafter the coronary angiography and maintained 0. 1 μg/（min· kg） for 36 h in the oh, servation group, but not in thecontrol group. The subcutaneous injection of low molecular weight heparin was applied for 5 -7 days after the operation. The coagulation tests and blood cell analysis were performed at 12 h and 5 d. The level of NT-proBNP was determined before the operation and one week after the operation. All patients were followed up for 3 months. TIMI classification in the PCI, level of NT-proBNP, incidence of majorcardiovascularevents andbleeding-related complications were compared between the two groups. Results There was nostatistical significance in general data （ P 〉 0. 05 ）. The coronary flow, incidence ofthe no-reflow and slow-fellow phenomenaof the observation group was better than the control group after the operation, the difference was statistic difference, P = 0. 005. There was no statistical significance inthe levels of NT-proBNP before PCI between the two groups（P 〉0.05）. The levels of NT-proBNP decreased one week after PCI in both groups, especially in the observation group（ P = 0. 009 ）. The follow-up revealed that incidence of major- cardiovascularevents in the observation group was lower as compared with the control group （ P = 0. 042 ）. The rate of bleeding-related complications was similar in the two groups （P = 0. 906）. Conclusion Tirofiban in elective PC/surgery can improve the myocardial perfusion, promote the recovery of cardiac function, reduce incidence of the majorcardiovascular events, without raising the risk for bleeding-related complications.