冠状动脉内注射替罗非斑治疗急性冠状动脉综合征介入治疗后无复流的临床观察

Treatment with tirofiban on no-reflow in patients with acute coronary syndrome after percutaneous coronary intervention

目的评价冠状动脉内注射替罗非斑对急性冠状动脉综合征(acute coronary syndrome,ACS)介入治疗后无复流患者心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血流的影响及安全性。方法 ACS患者行支架植入术后判定无复流者57例,按随机数字表法随机分为替罗非斑组(冠状动脉内注射替罗非斑10μg/kg)33例,硝酸甘油组(冠状动脉内注射硝酸甘油200μg)24例。观察两组给药后30 min的TIMI血流分级及校正的TIMI计帧数(CTFC),2 d后安全性的终点及30 d主要心血管事件(major adverse cardiovascular events,MACE)发生率。结果替罗非斑组介入治疗后无复流患者TIMI 3级血流获得率显著高于硝酸甘油组,差异有统计学意义(81.8%vs.16.7%,P<0.05);校正的TIMI计帧数显示替罗非斑组血流快于硝酸甘油组,差异有统计学意义[(62±18)帧数vs.(90±17)帧数,P<0.01]。替罗非斑组30 d MACE发生率低于硝酸甘油组,但差异无统计学意义(9.1%vs.12.5%,P>0.05)。两组均未见血小板减少。结论冠状动脉内注射替罗非斑治疗ACS介入治疗后无复流患者是有效和安全的。

Objectives To evaluate the efficacy and safety of intracoronary tirofiban on thrombolysis in myocardial infarction （TIMI） flow in acute coronary syndrome （ACS） patients with no-reflow after percutaneous coronary intervention （PCI）. Methods Fifty-seven ACS patients with no=reflow after stenting were randomized to tirofiban group （intraeoronary tirofiban, 10 μg/kg, n=33） and nitroglyceride group （intraeoronary nitroglyceride, 200 μg, n=24）. Targets to be observed consisted of corrected TIMI frame count （CTFC）, TIMI flow grade 30 minutes after medication, safety end points 2 days after PCI and incidence of major adverse cardiovascular events （MACE） 30 days after PCI. Results Patients with TIMI grade 3 flow were markedly more in tirofiban group than in nitroglyceride group （81.8% vs. 16.7% ,P〈0.05）.CTFC showed that coronary blood flow in tirofiban group was significantly faster than that in nitroglyceride group （62±18 vs. 90±17, P〈0.01 ）. No significant difference was found in incidence of MACE 30 days after PCI between the two groups （9.1% vs. 12.5%,P〉0.05）. No thrombocytopenia was observed in the two groups. Conclusions Administration of intracoronary tirofiban is effective and safe for ACS patients with no-reflow after PCI.