静脉溶栓联合替罗非班治疗急性ST段抬高型心肌梗死的临床观察

Clinical observation of intravenous thrombolysis combined with tirofiban in the treatment of ST-segment elevation acute myocardial infarction

目的观察急性ST段抬高型心肌梗死（STEAMI）采用阿替普酶静脉溶栓联合国产替罗非班治疗的疗效及安全性。方法选取2012年5月～2013年7月本院收治的30例STEAMI患者作为常规组，均符合WHO的诊断标准且≤3h能接受溶栓治疗并在7d内完成冠状动脉造影（CAG）。选取2013年9月-2014年11月收治的32例STEAMI患者作为联合组，在采用阿替普酶溶栓的同时应用替罗非班。两组均配合肝素注射液持续静脉泵入48h，记录心电图、心肌酶谱、活化部分凝血酶时间、CAG，观察冠脉再通指标、药物不良反应，评价近期疗效和安全性。结果联合组的CK—MB峰值、CK—MB达峰值时间、心电图sT段回落≥50％例数、院内再次心肌梗死例数与常规组比较．差异无统计学意义（P〉0．05）。联合组5～7d梗死相关血管（IRA）血流〉TIMIⅢ级、7d内发生不稳定型心绞痛的例数与常规组比较，差异有统计学意义（P〈0．05）。两组的溶栓24h后凝血酶原时间比较，差异有统计学意义（P〈0．05）。两组的血小板计数和出血事件比较，差异无统计学意义（P〉0．05）。结论≤3h的STEAMI在静脉溶栓的同时联合应用国产盐酸替罗非班在改善梗死相关血管TIMI血流、7d内不发生不稳定型心绞痛优于常规溶栓组，并未增加出血风险。

Objective To observe the efficacy and safety of intravenous thrombolysis with aheplase combined with domestic tirofiban in the treatment of ST-segment elevation acute myocardial infarction （STEAMI）.Methods 30 STEAMI patients admitted to our hospital from May 2012 to July 2013 were selected as the conventional group.These patients met the WHO diagnostic criteria,and could receive thrombolytic therapy ≤ 3 hours and underwent coronary angiography （CAG） within 7 days.32 STEAMI patients admitted to our hospital from September 2013 to November 2014 were selected as the combination group,and was given thrombolysis with aheplase and tirofiban therapy simultaneously.Patients from both groups were additionally given heparin injection via continuous intravenous infusion for 48 hours,ECG,myocardial enzymogram,activated partial thromboplastin time and CAG were recorded.The indicators of coronary recanalization and adverse drug reaction were observed,and the short-term efficacy and safety were evaluated.Results The peak value of CK-MB,peak time of CK-MB,the resolution of ST segment ≥ 50% and in-hospital myocardial infarction for a second time between the combination group and the conventional group were not significant difference （P〉0.05）. There were significant differences in 5-7 days infarct-related artery （IRA） blood flow 〉 TIMI grade m and the occurrence of unstable angina within seven days between the two groups （P〈0.05）.Prothrombin time prolongations at 24 h after thrombolysis between the two groups were significantly different （P〈0.05）.Platelet counts and bleeding events between the two groups were no significant difference （P〉0.05）.Conclusion Intravenous thrombolysis combined with domestic tirofiban hydrochloride in the treatment of STEAMI ≤ 3 hours is superior to the conventional thrombolysis group in improving the infarct-related artery TIMI blood flow,the non-occurrence of unstable angina within 7 days, which is not increase the risk of bleeding.