急诊PCI术前静脉应用替罗非班联合术中冠脉内小剂量给药临床研究.docVIP

急诊PCI术前静脉应用替罗非班联合术中冠脉内小剂量给药临床研究 　　【摘要】 目的 探讨急诊经皮冠状动脉介入治疗（PCI）术前静脉应用替罗非班联合术中冠脉内小剂量给药的疗效和安全性。方法 102例行急诊PCI的急性ST段抬高型心肌梗死（STEMI）患者， 随机分为研究组（52例）和对照组（50例）。研究组术前应用替罗非班， 对照组术前未应用。比较两组梗死相关动脉（IRA）自发再通率， PCI术中慢血流、无复流发生率， 术后7 d主要心血管事件（MACE）及出血事件发生率。结果 研究组介入治疗前冠脉造影提示IRA自发再通率高于对照组， 术中慢血流、无复流的发生率要低于对照组， 组间比较， 差异有统计学意义（P0.05）。两组均未发生严重出血事件。结论 急诊PCI术前静脉应用替罗非班联合术中冠脉内小剂量给药的方法在IRA血流改善方面优于术中冠脉内给药， 同时不增加出血风险。 　　【关键词】 急性心肌梗死；介入治疗；替罗非班 　　【Abstract】 Objective To investigate the curative effect and safety of preoperative tirofiban combined with intraoperative small dose intracoronary administration in emergency percutaneous coronary intervention （PCI） surgery. Methods A total of 102 patients with acute ST-segment elevation myocardial infarction （STEMI） were randomly divided into research group （52 cases） and control group （50 cases）. Tirofiban was given to the research group before operation， while not to the control group. Comparisons were made on spontaneous recanalization rate of infarction related artery （IRA）， incidences of slow flow and no-reflow in PCI， and incidences of major adverse cardiovascular events （MACE） and bleeding events in 7 d after PCI between the two groups. Results The research group had higher spontaneous recanalization rate of IRA showed by coronary angiogram than the control group， and its incidences of slow flow and no-reflow were lower than the control group. The differences between the two groups had statistical significance （P0.05）. Both groups had no severe bleeding events. Conclusion Preoperative tirofiban combined with intraoperative small dose intracoronary administration in emergency PCI surgery provides better effect in improvement of IRA flow than intraoperative intracoronary administration， without risk of bleeding as well. 　　【Key words】 Acute myocardial infarction； Interventional therapy； Tirofiban 　　急诊PCI可以迅速开通STEMI患者罪犯血管， 但术中易发生“慢血流”和“无复流”， 严重影响STEMI患者的近、远期预后， 而血管远端微循环血栓栓塞是其发生的主要机制。替罗非班是一种非肽类小分子血小板糖蛋白Ⅱb/Ⅲa受体抑制剂（GPI）， 作用在血小板聚集的最后环节， 具有非常强的抗血小板聚集作