不同时机给予替罗非班对急性心肌梗死患者介入术后冠脉血流及并发症的影响

Effects of Titrofiban with Different Medication Timing on Blood Flow and Complications in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

目的：探讨不同时机给予替罗非班对急性心肌梗死患者经皮冠状动脉介入（PCI）术后冠脉血流以及并发症的影响。方法：214例急性ST段抬高型心肌梗死患者依据入院先后顺序分为晚期组98例和早期组116例,前者在PCI术后回到病房时静脉推注替罗非班,后者在进入急诊室前（PCI术前）1~2 h静脉推注替罗非班,比较两组制剂注射-球囊扩张时间,患者手术前后冠脉心肌梗死溶栓治疗（TIMI）血流分级、心功能及微循环灌注指标和住院期间并发症。结果：早期组注射替罗非班至球囊扩张时间为3~40 min,晚期组为30~65 min,差异具有统计学意义（t=8.94,P=0.00）;早期组患者造影时,梗死相关动脉（IRA）前向血流达到2级和3级的患者数分别为16例（13.8%）和20例（17.2%）,较晚期组比例[7例（7.1%）、9例（9.2%）]更高,差异具有统计学意义（P〈0.05）;PCI术后,两组患者的闭塞血管全部打通,早期组2例无再流,晚期组6例无再流,两组患者TIMI血流分级为3级的例数比较,差异无统计学意义（χ2=1.21,P〉0.05）;两组患者术后4、8 h的肌酸激酶同工酶含量与术后24 h左室射血分数相似,差异无统计学意义（P〉0.05）;早期组患者ST段回落值为（1.93±0.57）mm,显著高于晚期组的（1.07±0.29）mm,差异有统计学意义（P〈0.05）;早期组患者心脏不良事件发生率和出血并发症发生率为3.45%和7.76%,晚期组为4.08%和5.10%,差异无统计学意义（P〈0.05）。结论：不同用药时机对替罗非班的安全性无显著影响,且临床预后和造影结果一致,但早期用药可改善PCI术前IRA前向血流量,为更佳的给药时机。

OBJECTIVE： To explore the effects of tirofiban with different medication timing on blood flow and complications in patients with acute myocardial infarction after percutaneous coronary intervention （PCI）. METHODS： 214 cases of acute ST-seg- ment elevation myocardial infarction were divided into late stage group （n=98） and early stage group （n= 116） based on the order of admission. Te latter was given intravenous injection of tirofiban after PCI; the former was given intravenous injection of tirofi- ban before entered emergency room [1-2 h before PCI]. The injection-balloon dilation time was compared between 2 groups. The coronary TIMI flow situation, cardiac function and microcirculatory perfusion index before and after operation, and complications during hospitalization were also compared. RESULTS： Intravenous injection of tirofiban to balloon dilation time were 3-40 min in early stage group, and 30-65 min in late stage group, with statistical significance （t=8.94, P=0.00） ; during angiography, the number of patients with IRA prorsal blood flow rate to reach 2 and 3 grade was 16 cases （13.8% and 20 cases （17.2%） in early stage group, which were higher than in late stage group [7 cases （7.1%）, 9 cases （9.2%）], with statistical significance （P〈 0.05）. After PCI, occluded artery of 2 groups opened up, there were 2 cases of no-reflow in early stage group and 6 cases of no-re- flow; there was no statistical significance in 3 grade blood flow of TIMI between 2 groups （χ2= 1.21, P〉0.05）. The amount of 4 and 8 h creatine kinase MB, and postoperative 24 h LVEF of 2 groups were similar after operation, without statistical significance （P〉0.05） ; ST segment of early stage group drop value was （1.93 ± 0.57） mm, which was significantly higher than that of late stage group （1.07 ± 0.29）mm, with statistical significance （P〈0.05） ; the incidence of cardiac adverse events and bleeding compli- cation were 3.45% and 7.76% in early stage group, and 4.08% and 5.10% in late-stage group, without statistical significance （P〈 0.05）. CONCLUSIONS： Different medication timing has no significant effect on the safety of tirofiban, but clinical outcomes and angiographic results are consistent. However, early treatment can improve IRA prorsal blood flow rate before PCI, which is the good medication timing of tirofiban.