心肌梗死患者急诊经皮冠状动脉介入术应用替罗非班的临床观察

The Clinical observation of application of tirofiban on patients with acute myocardial infarction during emergency PCI

目的：探讨应用替罗非班行急诊经皮冠状动脉介入（PCI）治疗对急性心肌梗死患者的影响及临床意义。方法将112例行急诊 PCI 治疗的急性 ST 段抬高型心肌梗死（STEMI）患者按随机分配表法分为试验组和对照组。试验组行 PCI 时冠脉内注入负荷量替罗非班10μg／kg，然后以0．15μg＆#183;kg －1＆#183;min －1静脉维持泵入24～36 h，对照组不使用替罗非班。观察比较两组术后血流 TIMI 分级，校正的 TIMI 计帧数，血清hs-CRP 和 LVEF 等指标，及主要不良心脏事件发生率、出血发生率。结果冠脉介入术后冠脉血流 TIMI 3级比率试验组明显高于对照组（93．8％∶79．2％，P ＜0．01）；TIMI 帧数显示冠脉血流试验组明显快于对照组（23．1±5．9）帧∶（32．4±4．8）帧，P ＜0．01；术后血清 hs-CRP 试验组明显低于对照组（7．2±0．8）∶（9．6±1．1），P ＜0．01；术后1周的 LVEF 值，试验组明显高于对照组（68．7％±8．5％）∶（55％±9．2％），P ＜0．01。术后1个月随访，两组在主要心血管事件的发生率上差异有统计学意义（P ＜0．05）。两组在主要出血事件的发生率上差异无统计学意义（P ＞0．05）。结论急性 ST 段抬高型心肌梗死患者急诊 PCI 治疗使用替罗非班可以明显改善冠脉血流、心肌灌注和心功能，且并未明显增加主要出血事件的发生率，改善近期预后。

Objective To explore the effects and the clinical signifcance of early application of tirofiban in patients with acute myocardial infarction （STEMI）before primary pereutaneous coronary intervention （PCI）.Method A total of 112 STEMI patients were divided into tirofiban group（n =56）and control group（n =56）according to whether intracoronary using tirofiban.TIMI grade,corrected TIMI frame count（CTFC）,hs-CRP and LVEF after PCI operation and the incidence of major adverse cardiac events and bleeding case were compared between two groups.Re-sults The percentage of TIMI 3 flow achieved in tirofiban group after PCI was higher than that in control （93.8%∶79.2%,P〈0.01）.The TIMI frame count showed coronary blood flow in the tirofiban group was significant-ly faster than the control group （23.1 ±5.9）frame∶（32.4 ±4.8）frame,P〈0.01.The postoperative hs-CRP of tiro-fiban group was significantly lower than that in the control group （7.2 ±0.8）∶（9.6 ±1.1）,P〈0.01;the LVEF val-ues of one week after operation in experimental group was significantly higher （68.7% ±8.5%）∶（55% ±9.2%）, P〈0.01.Conclusion The tirofiban can significantly improve coronary blood flow,myocardial perfusion and cardiac function in STEMI patients with emergency PCI therapeutic,and don′t significantly increase the incidence of major bleeding events,which may improve short-term prognosis.