急诊冠状动脉介入治疗患者早期应用替罗非班的疗效及安全性观察

Curative effect and safety of early administration of tirofiban in patients with emergency coronary intervention

目的探讨急诊经皮冠状动脉介入(PCI)治疗术前采用替罗非班治疗急性ST段抬高型心肌梗死(STEMI)患者的临床疗效及安全性。方法择2012年1月至2013年12月在山西省心血管病医院CCU住院并行急诊PCI治疗的STEMI患者共计134例。随机分为观察组(69例)和对照组(65例)。比较两组患者冠状动脉造影情况、术后TIMI血流、心电图ST段抬高总和回落百分比(sum STR)、住院期间1周内和术后90天主要不良心脏事件的发生率、左室射血分数(LVEF)、术前和术后24h及1周血小板计数、出血事件的发生率。结果两组间一般临床资料、冠状动脉造影情况差异均无统计学意义(P均>0.05)。观察组术后TIMI血流Ⅲ级的比例高于对照组,但差异无统计学意义(97.1%vs.92.3%,P>0.05),而术后90分钟sum STR>50%的比例观察组明显高于对照组,差异有统计学意义(94.2%vs.80.0%,P<0.05);观察组住院期间1周内顽固性心绞痛及主要不良心脏事件(MACE)的发生率(2.9%vs.13.8%,4.3%vs.15.4%,P均<0.05)明显降低,术后90天MACE的发生率较对照组无明显变化(1.4%vs.3.1%),而LVEF[(53.86±4.50)%vs.(52.03±4.10)%,P<0.05]显著提高。两组患者术前和术后24h、1周血小板计数以及出血事件的发生率相比,差异均无统计学意义(P均>0.05)。结论早期应用替罗非班可显著提高STEMI患者的心肌细胞灌注,改善微循环,从而改善左心功能和临床预后,且并未增加出血风险。

Objective To investigate the clinical efficacy and safety of tirofiban administrated before emergency percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods STEMI patients with PCI （n=134） were chosen from Jan. 2012 to Dec. 2013, and randomly divided into observation group （n=69） and control group （n=65）. The outcomes of coronary angiography （CAG）, TIMI flow, sumSTR of electrocardiogram （ECG）, incidence of major adverse cardiovascular events （MACE） within 1 w after hospitalization and 90 d after PCI, LVEF, platelet count （PLT） and incidence bleeding events before and 24 h and 1 w after PCI were compared between 2 groups. Results The difference in general clinical data and CAG outcomes had no statistical significance （all P〉0.05） between 2 groups. The proportion of patients with grade III TIMI flow after PCI was higher in observation group than that in control group （97.1%vs. 92.3%, P〉0.05）, while proportion of patients with sumSTR〉50%after PCI for 90 min was significantly higher in observation group than that in control group （94.2%vs. 80.0%, P0.05）. Conclusion Early administration of tirofiban can significantly promote the perfusion of myocardial cells and microcirculation, and improve left cardiac function and clinical prognosis without increasing bleeding risks.