中高危非ST段抬高型急性冠状动脉综合征患者早期应用盐酸替罗非班临床效果分析

Effect of upstream application of tirofiban in patients with moderate-high risk non-ST elevation acute coronary syndrome

目的 探讨中高危非ST段抬高型急性冠状动脉综合征（NSTACS）患者早期应用盐酸替罗非班的临床效果.方法 选择2009年5月至2010年7月于首都医科大学附属北京安贞医院心内科住院拟行冠状动脉介入（PCI）治疗的中高危NSTACS患者182例,完全随机分为观察组（80例）和对照组（102例）,所有患者均择期接受PCI治疗,观察组于导管室上游（早期）应用盐酸替罗非班,对照组于PCI开始时应用盐酸替罗非班,观察2组冠状动脉病变及支架置入情况、罪犯血管血流灌注、血清肌酸激酶和心肌肌钙蛋白Ⅰ（cTnI）水平及院内、术后30 d主要心血管不良事件发生情况和出血情况.结果 2组患者手术径路、病变狭窄程度、多支病变比例、慢性闭塞性病变、长病变（＞ 20 mm病变）、分叉病变、血栓性病变比例、平均置入支架数、支架直径、支架长度比较,差异均无统计学意义（均P＞0.05）.2组术前、术后罪犯血管心肌梗死溶栓（TIMI）分级及术前TIMI心肌灌注（TMPG）分级比较,差异均无统计学意义（均P＞0.05）.观察组术后罪犯血管TMPG分级＜3的比例明显低于对照组[6.2％ （5/80）比15.7％ （16/102）],差异有统计学意义（P＜0.05）.观察组和对照组术后48 h血清肌酸激酶、cTnI水平明显低于术前[观察组：（5±4）U/L比（21±10）U/L,（0.8±0.4）μg/L比（4.0±1.7） μg/L;对照组：（9±3）U/L比（20±11）U/L,（1.1±0.9） μg/L比（4.6±1.8） μg/L],且观察组术后48 h血清肌酸激酶和cTnI水平明显低于对照组,差异均有统计学意义（均P＜0.05）.2组患者术后30 d均未见心血管不良事件.2组患者出血事件发生率比较,差异无统计学意义（P＞0.05）,且盐酸替罗非班减量或停用后出血症状均消失,未见严重出血事件.结论 早期应用盐酸替罗非班可以改善接受PCI治疗的中高危NSTACS患者罪犯血管区域的心肌组织灌注,且未增加出血事件发生率.

Objective To analyze the clinical effect of upstream application of tirofiban in patients with moderate-high risk non-ST acute coronary syndrome （NSTACS）.Methods Totally 182 patients with NSTACS who received elective percutaneous coronary intervention（PCI） from May 2009 to July 2010 were randomly divided into observation group （80 cases） given upstream application of tirofiban （before PCI） and control group（102 cases） given tirofiban from the onset of PCI.The characteristics of coronary lesions,stenting implantation,flow perfusion of the culprit vessel （CV）,creatine kinaseand cardiac troponin Ⅰ （cTNI） in serum,major adverse cardiovascular events （MACE） in hospital and 30 days after PCI,haemorrhage were observed and compared between the two groups.Results The access site,degree of stenosis,proportion of multivessel lesion,proportion of chronic occlusion lesion,proportion of long lesion （〉 20 mm）,proportion of bifurcation lesion,proportion of thrombotic lesion,stent number,stent diameter,stent length had no statistical differences between the two groups （P 〉 0.05）.The pre-and postoperative thrombolysis in myocardial infarction （TIMI） flow grade and preoperative TIMI myocardial perfusion grade （TMPG） showed no significantly differences between the two groups （P 〉 0.05）;the proportion of TMPG 〈 3 in observation group was significantly lower than that of control group [6.2% （5/80） vs 15.7% （16/102）] （P 〈 0.05）.The level of serum creatine kinase and cTNI 48 h after operation were significantly decreased compared with those before operation in observation group[（5 ±4） U/L vs （21 ± 10） U/L,（0.8 ±0.4） μg/L vs （4.0 ± 1.7） μg/L] and control group [（9 ± 3） U/L vs （20 ± 11） U/L,（1.1 ± 0.9） μg/L vs （4.6 ± 1.8） μg/L],also being significantly different between the two groups （P 〈 0.05）.No MACE occurred in both groups.No significant difference of incidence of haemorrhage was found between the two groups （P 〉 0.05）;after stopping or reducing the dose of tirofiban,the haemorrhage symptom disappeared and no serious haemorrhage was observed.Conclusion Upstream using of tirofiban may improve myocardial perfusion of CV,without increasing the incidence of haemorrhage in patients with moderate-high risk NSTACS receiving PCI.