急性前壁心肌梗死患者介入治疗早期应用替罗非班的疗效观察.DOCVIP

临床医学论文-急性前壁心肌梗死患者介入治疗早期应用替罗非班的疗效观察 ????????????????????? 作者：林忠伟, 王卓，朱桂平, 雷达,周万兴?? 【摘要】? 目的 探讨急性前壁心肌梗死患者急诊介入治疗早期联合应用替罗非班的临床疗效及安全性。方法 我院2004年5月～2007年10月心内科住院治疗的急性前壁心肌梗死患者70例,年龄45～80(60.7±7.5)岁,随机分为替罗非班治疗组(n=36)和对照组(n=34), 治疗组在介入术前常规给予阿司匹林、氯吡格雷、阿托伐他汀等治疗,同时静脉加用盐酸替罗非班,以输液泵持续泵入;对照组除未加盐酸替罗非班外,其他治疗同治疗组。观察两组术中再灌注血管终末段显影祯数和术后90 min内ST段回落情况、肌酸激酶同工酶(CKMB)酶峰时间,术中及术后重要脏器出血情况、心衰发生率、术后1周心功能情况。结果 两组靶血管经皮冠状动脉介入(PCI)成功率均达100%,术中及术后出血事件、心衰、病死率差异无显著性；治疗组术中再灌注血管终末段显影祯数和术后90 min内ST段回落情况均优于对照组(P0.05)，术后治疗组CKMB酶峰时间较对照组提前(P0.05)；1周后心脏彩超评价心脏左室射血分数(LVEF)差别无显著性。结论 急性前壁心肌梗死患者急诊介入治疗早期联合应用替罗非班安全、有效,能改善冠脉微循环及心肌灌注。 【关键词】? 急性心肌梗死;经皮冠状动脉介入治疗;替罗非班 ??? Abstract:Objective To analyze the efficacy and safety of tirofiban treatment combined with emergency percutaneous coronary intervention (PCI) in the patients with acute anterior wall myocardial infarction. Methods 70 patients diagnosed with anterior wall myocardial infarction with the age from 45 to 80 from July, 2004 to October, 2007 in our hospital were divided randomly into tirofiban treatment group (n=36) and control group (n=34). Both of them were administered with aspirin, clopidogrel and atorvastatin before PCI, the treatment group was treated with tirofiban infused with infusion pump during and after the operation. The treatment in the control group was the same as that in the treatment group except that no tirofiban was infused. The number of developed frame of terminal re-perfused vessel, lowering of ST segment 90 min after PCI, the time to peak serum CKMB levels, blooding and the rate of heart failure one week after PCI were compared between the two groups. Results The rates of opening of the target vessel in the two groups were 100%. The blooding, the rate of heart failure and death occurred in both groups were not statistically significant. The number of developed frame of terminal reperfused vessel and lower level of ST segment 90 min after PCI in tirofiban treatment group were lower than those in the control group (P0.05). Time to peak