早期应用替罗非班对冠心病PCI术后患者血小板功能的影响

Effect of early application of tirofiban on platelet function in patients with coronary heart disease after PCI

目的探究早期替罗非班应用对经皮冠状动脉介入治疗(PCI)术后的冠状动脉粥样硬化性心脏病(冠心病)患者血小板功能的影响。方法连续入选2016年2月~2017年3月于深圳市第三人民医院行PCI治疗的冠心病患者78例,在PCI术前随机分为替罗非班组和对照组,替罗非班组在术前静脉推注10ug/kg替罗非班,术后继续以0.15 ug/kg/min静脉滴注18 h,术后两组均以氯吡格雷片、阿司匹林肠溶片进行常规抗凝治疗,比较两组治疗前后血小板功能的差异。结果治疗前两组的血小板粘附率、血小板聚集率、最大聚集时间及P选择素浓度无统计学意义(P>0.05);治疗后替罗非班组血小板粘附率、血小板聚集率、最大聚集时间及P选择素浓度低于对照组(P<0.05)。且两组出血并发症的发生率(17.1%vs.16.2%)无统计学意义(P>0.05);治疗组心血管事件包括急性血栓、术中慢血流/无复流及再闭塞的发生率显著低于对照组(P<0.05),但两组再发心绞痛的发生率无统计学意义(5.4%vs.17.1%,P>0.05)。结论早期推注替罗非班可有效地抑制PCI患者血小板功能,且安全性较高。

Objective To investigate the effect of early tirofiban on platelet function in patients with coronary artery disease after percutaneous coronary intervention （PCI）. Methods 78 patients with coronary heart disease who underwent PCI were enrolled from February 2016 to March 2017. They were randomly divided into tirofiban group and non-tirofiban group. The patients in the two groups were treated with clopidogrel tablets and aspirin enteric-coated tablets. The patients were treated with intravenous infusion of 10 μg/kg tirofiban and 0.5 μg/kg/min after PCI. Differences in platelet function between the two groups before and after treatment were compared. Results Before PCI, the platelet adhesion rate, platelet aggregation rate, maximal aggregation time and P-selectin concentration were not significantly different between the tirofiban group and the control group （P〉0.05）. After PCI, those above in tirofiban group were lower than those in control group （P〈0.05）. And there was no statistical significance of the incidence of bleeding complications between two groups （17.1% vs. 16.2%, P〉0.05）. The incidence of slow thrombosis, no-reflow and re-occlusion in the treatment group was significantly lower than those in the control group （P〈0.05）, but there was no statistical significance of the incidence of recurrent angina between two groups （5.4% vs. 17.1%, P〉0.05）. Conclusion Early bolus tirofiban can effectively inhibit the platelet function of PCI patients, and it is safer.