替罗非班治疗急性冠脉综合征介入治疗中无复流疗效和安全性观察.docVIP

替罗非班治疗急性冠脉综合征介入治疗中无复流疗效和安全性观察 　　摘 要 目的：评价冠状动脉内应用血小板GPⅡb/Ⅲa受体拮抗药替罗非班对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)中无复流的临床疗效和安全性。方法：将行PCI治疗中发生无复流的ACS患者56例随机分为替罗非班治疗组(28例)和对照组(28例)。PCI术中出现无复流现象后分别给予冠状动脉内注入替罗非班和硝酸甘油。观察给药后20分钟TIMI血流分级，2天后安全性的终点及2周内主要不良心血管事件(MACE)发生率。结果：替罗非班组介入中无复流患者TIMI 2～3级血流获得率明显高于硝酸甘油组；替罗非班组2周内的MACE发生率明显低于硝酸甘油组；替罗非班组出血不良反应较硝酸甘油组略高，但差别无统计学意义，两组均未发生严重内脏出血事件。结论：冠脉内注射替罗非班可明显降低和改善ACS患者PCI后无复流现象，而且不增加出血事件发生率，是一种安全有效的PCI辅助治疗方法。 　　关键词 急性冠脉综合征 替罗非班 无复流现象 介入治疗 　　doi:10.3969/j.issn.1007-614x.2012.07.052 　　Abstract Objective:To evaluate the clinical efficacy and safety of platelet GPⅡb/Ⅲa antagonist-Tirofiban by intracoronary administration on acute coronary syndrome(ACS)patients during percutaneous coronary intervention(PCI)with no reflow.Method:56 ACS patients with on reflow during PCI were randomly divided into tirofiban group(28)and control group(28).Tirofiban and nitroglycerin were given respectively by intracoronary administration after the no reflow phenomenon appeared during the PCI.20 minutes later,the TIMI flow grade was observed,2 days later the safety end point was observed,incdence of major adverse cardiovascular events(MACE) were observed within 2 weeks.Result:The TIMI2～3ratio in tirofiban group(92.8%)was higher than nitroglycerin group(32.1%)(P＜0.01).The incidence of MACE in the tirofiban group(7%)was significantly less than nitroglycerin group(P＜0.01).The hemorrhage adverse reaction in the two groups were no significantly differences(P＞0.05).Both of the two groups had no serious visceral hemorrhage events.Conclusion:Intracoronary administration of tirofiban can reduce the no reflow phenomenon on acute coronary syndrome patients during the PCI,and didnt increase hemorrhage events,is a safe and effective adjuvant therapeutic method during the PCI. 　　Key Words Acute coronary syndrome;Tirofiban;No reflow phenomenon;Percutaneous coronary intervention 　　急性冠脉综合征(ACS)是心血管疾病危重症，其病死率高，经皮冠状动脉介入治疗(PCI)是目前治疗ACS的主要治疗策略。本文旨在探讨冠状动脉内注入国产血小板GPⅡb/Ⅲa受体拮抗药替罗非班对无复流的临床疗效和安全性。