替罗非班在不同入径经皮冠状动脉介入术治疗急性冠状动脉综合征中的出血风险评价

Evaluation of bleeding risk in patients with acute coronary syndrome treated with tirofiban after different percutaneous coronary interventions

目的：探讨替罗非班在不同入径经皮冠状动脉介入术（ PCI）治疗急性冠状动脉综合征（ ACS）中的出血风险。方法回顾性分析我院ACS患者403例，按照是否应用替罗非班分为替罗非班组和非替罗非班组，评估两组中不同入径PCI的出血事件发生率。结果桡动脉入径中，替罗非班组与非替罗非班组不明显出血事件发生率的比较差异无统计学意义（6．87％比5．10％，χ2＝0．075， P＝0．784）。股动脉入径中，替罗非班组不明显出血事件发生率明显高于非替罗非班组（23．15％比9．09％，χ2＝4．610，P＝0．031）。桡动脉入径中，替罗非班组与非替罗非班组穿刺部位出血发生率的比较差异无统计学意义（1．53％比1．02％，χ2＝0．064，P＝0．799）。股动脉入径中，替罗非班组穿刺部位出血发生率明显高于非替罗非班组（15．74％比4．55％，χ2＝4．006，P＝0．045）。股动脉入径中替罗非班组不明显出血事件及穿刺部位出血发生率均明显高于桡动脉入径中替罗非班组（χ2＝11．555，P＝0．0006；χ2＝14．459，P＝0．0001）。结论替罗非班在经桡动脉入径PCI治疗ACS中出血事件发生率较低，且明显低于经股动脉入径，可遵循指南进行个体化合理应用。

Objective To explore the bleeding risk in patients with acute coronary syndrome （ ACS） treated with tirofiban after percutaneous coronary intervention （ PCI） with different approaches . Methods Retrospective analysis of 403 patients with ACS in our hospital was performed .According to whether tirofiban was used,those patients were divided into the tirofiban group and the non-tirofiban group.The rate of bleeding events after PCI was assessed in both groups . Results For the radial artery approach , there was no significant difference on the rate of non-severe bleeding events between tirofiban group and the non-tirofiban group（6.87% vs.5.10%,χ2 =0.075, P =0.784 ） .For femoral artery approach , the rate of non-severe bleeding events was significantly higher in tirofiban group than in non-tirofiban group（23.15%vs.9.09%,χ2 =4.610,P=0.031）.For the radial artery approach,there was no significant difference on the rate of bleeding of puncture site between tirofiban group and non-tirofiban group（1.53%vs.1.02%,χ2 =0.064,P=0.799）.For the femoral artery approach ,the rate of bleeding of puncture site was significantly higher in tirofiban group than in non-tirofiban group（15.74% vs.4.55%,χ2 =4.006,P=0.045）.The rate of non-severe bleeding events and bleeding of puncture site of tirofiban was significantly higher in the femoral artery approach than radical artery approach （χ2 =11.555,P=0.0006 andχ2 =14.459,P=0.0001 respectively）. Conclusions Compared with the femoral artery approach ,the rate of bleeding events of tirofiban in patients with ACS treated by PCI is lower in the radial artery approach .It is recommended to be used individually based on guidelines.