小剂量替罗非班在急性心肌梗死静脉溶栓中应用.docVIP

小剂量替罗非班在急性心肌梗死静脉溶栓中应用 　　doi：10.3969/j.issn.1007-614x.2014.12.15 　　摘 要 目的：观察小剂量替罗非班在急性心肌梗死（AMI）患者溶栓治疗中的有效性和安全性。方法：106例AMI患者随机分为对照组和治疗组，每组53例。对照组采用标准的溶栓方案，治疗组在标准的溶栓方案基础上加用小剂量替罗非班。采用判断溶栓再通间接指标来评估两组梗死相关血管的再通率；观察患者出血的发生率及病死率。结果：与对照组比较，治疗组溶栓再通率明显提高（P0.05）。结论：替罗非班能提高梗死相关血管的开通率，降低病死率。 　　关键词 小剂量替罗非班 急性心肌梗死 溶栓治疗 　　Application of small dose of tirofiban in the thrombolytic therapy of acute myocardial infarction 　　Zhang Yongtao，Zhang Xiaotao 　　The Community Health Service Centre of Xicheng District，Rongcheng City，Shandong 264300 　　Abstract Objective：To observe the efficacy and safety of small dose of tirofiban in the thrombolytic therapy of patients with acute myocardial infarction（AMI）.Methods：106 patients with AMI were randomly divided into the control group and the treatment group with 53 cases in each.The control group was used standard thrombolytic regimen，the treatment group was used small dose of tirofiban on the basis of standard thrombolytic regimen.Judgment thrombolytic recanalization indirect indicators were used to assess the recanalization rate of infarct-related artery of two group.We observed the incidence rate and mortality of patients with bleeding.Results：Compared with the control group，the thrombolytic recanalization rate of the treatment group was significantly improved（P0.05）.Conclusion：Tirofiban can increase the recanalization rate of infarct-related artery and reduce mortality. 　　Key words Small dose of tirofiban；Acute myocardial infarction；Thrombolytic therapy 　　资料与方法 　　2010年5月-2013年5月收治AMI患者106例，男66例，女50例，年龄48～72岁，平均60.2岁。所有患者均符合AMI诊断标准[1]，并具备下列条件：①病史提示AMI伴左束支传导阻滞两个或两个以上相邻导联ST段抬高（肢体导联≥0.1mV、胸前导联≥0.2mV），起病时间12小时，年龄75岁；②无溶栓禁忌证。梗死部位：前间壁30例，广泛前壁19例，下壁+右室22例，下壁35例。所有患者发病到入院的时间间隔均2～10小时。根据入院时间将所有患者随机分为对照组和治疗组，每组53例。患者入院后明确诊断立即给予溶栓治疗。对照组给予标准的溶栓治疗，治疗组在对照组治疗方法的基础上给予小剂量替罗非班。 　　治疗方法：入院后对照组立即进行吸氧、镇静、止痛，同时建立静脉通道，进行心电监护，根据临床情况给予口服血管紧张素转换酶抑制剂、调脂药物、β受体阻滞剂，同时立即给予300mg肠溶阿司匹林嚼服，氯吡咯雷300mg口服，静脉注射肝素5000U。溶栓时rt-PA（爱通立）100mg在90分钟内静脉给予。经患者本人及家属知情同意后，治疗组在对照组治疗基础上溶栓时加