急性ST段抬高心肌梗死急诊介入治疗中冠脉内注射替罗非班对TIMI血流和临床预后影响.docVIP

急性ST段抬高心肌梗死急诊介入治疗中冠脉内注射替罗非班对TIMI血流和临床预后影响 　　【摘要】 目的 观察急性ST段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术中冠脉内直接注射替罗非班的临床效果和安全性。方法 符合急性STEMI入选标准的患者112例，随机分为静脉组和冠脉组。静脉组静脉推注后持续泵入，冠脉组冠脉内推注后持续泵入。观察两组冠脉造影资料、PCI术开始时和结束时的冠脉TIMI血流分级、不良心脏事件、出血等并发症。结果 与静脉组相比，冠脉组PCI后TIMI血流分级和血栓情况改善明显(P0.05)；14 d的心功能、主要心脏不良事件、出血等无差别。结论 对急性STEMI患者，急诊PCI术中冠脉内应用替罗非班安全有效。 　　【关键词】 替罗非班；急性心肌梗死；冠状动脉介入治疗 　　 　　Clinical Application of Intra Coronary Administration of Tirofiban in Patients With Acute Myocardial Infarction During Percutaneous Intervention 　　WANG Peng-fei, JIN Wei-dong, XING Yong-sheng, et al. 　　Cardiovascular Dept of center Hospital,Xinxiang,Henan 453000,China 　　【Abstract】 Objective To evaluate the efficacy and safety of intracoronary administration of tirofiban on TIMI bleeding in percutaneous coronary intervention (PCI) patients with acute myocardial infarction (AMI). Methods 112 patients with AMI were randomized into two groups given tirofiban IV or IA. The efficacy of therapy, the adverse events(death, myocardial infarction, or urgent revascularizations)and major bleedingevents were recorded after 30 days of follow-up. Results Normal TIMI myocardial perfusion grade 3 flow after intracoronary administration of tirofiban bolus was noted in 91.4% of patients. The frequency of the adverse events and major bleeding events were the same among two groups. Conclusion Intracoronary administration of tirofiban bolus proved to be safe, and improved TIMI perfusion grade rapidly in patients with PCI, tirofiban as adjunctive treatment is associated with few adverse events. 　　【Key words】 Tirofiban；acute myocardial infarction； Percutaneous coronary intervention 　　 　　国内外临床试验证明，急性心肌梗死急诊PCI时静脉应用血小板膜糖蛋白(GP)Ⅱb/ Ⅲa 受体拮抗剂能提高TIMI血流分数，明显降低心脏不良事件，改善预后［1～4］。本研究旨在观察急诊 PCI术中冠状动脉内应用替罗非班的可行性和安全性。 　　1 资料与方法 　　1.1 研究人群 　　2008年1月至2009年9月确诊STEMI在我院行急诊PCI的住院患者。入选标准:(1)年龄75岁;(2)具备急诊PCI适应证;(3)知情同意接受急诊PCI。排除标准:①心功能≥KillpⅢ级;②合并急性心肌梗死机械并发症;③合并血液系统疾病;④近期外科大手术、活动性出血;⑤脑出血病史;⑥严重肾功能不全。共入选112患者，男86例，女26例，年龄38～73(66.1±10.2)岁；其中合并高血压