目的 评价急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)术中冠状动脉内注射替罗非班对梗死相关冠脉动脉血流的影响。方法 将98例AMI患者完全随机分为替罗非班组（46例）和常规治疗组（52例），对比2组PCI术后梗死相关冠脉动脉的心肌梗死溶栓试验(TIMI)分级、校正的TIMI计帧数，观察2组患者出血并发症发生率、住院期间和出院后6个月主要心血管事件(MACE)发生率。结果 PCI术后TIMI 3级血流获得率，替罗非班组(44/46，95.6％)高于常规治疗组(43/52，82.7％)，差异有统计学意义(P＜0.05)；校正的TIMI计帧数替罗非班组[(19.8±8.6)帧]低于常规治疗组[(28.3±5.8)帧]，差异有统计学意义(P＜0.01)。术后1周替罗非班组左心室射血分数[(54.2±6.7)％]高于常规治疗组[(49.6±8.1)％]，差异有统计学意义(P＜0.01)；出血并发症发生率高于常规治疗组，但差异无统计学意义(P＞0.05)。6个月内MACE发生率替罗非班组(2/46，4.3％)低于常规治疗组(9/52，17.3％)(P＜0.05)。结论 冠状动脉内注射替罗非班可明显改善AMI患者PCI术后的冠状动脉血流、心肌灌注及临床预后。%Objective To evaluate the effect of intracoronary injection of tirofiban on thrombolysis in myocardial infarction (TIMI) flow of infarct-related artery ( IRA ) in patients with acute myocardial infaction ( AMI )during emergency percutaneous coronary intervention (PCI). Methods Totally 98 STEMI patients were divided into tirofiban group (n =46) and routine group (n =52). The TIMI grade and corrected TIMI frame count(CTFC)following PCI operation were compared, and the bleeding condition as well as major adverse cardiac events ( MACE,including death, re-infarction and target vessel revascularization) in hospital and 6 months after discharge from hospital. Results There was a higher percentage of TIMI Ⅲ flow in tirofiban group following PCI (44/46,95.6％ vs 43/52,82.7％, P ＜0.05), and fewer TIMI frames as compared to the routine group (19.8 ± 8.6 frames vs 28.3 ±5.8 frames,P ＜ 0.01 ); The left ventricular ejection fraction (LVEF) one week after PCI was higher in tirofiban group(54.2 ±6.7％ vs 49.6 ±8.1％ ) ( P ＜0. 01 ) ; There was a higher prevalence in the complication of bleeding in tirofiban group but the difference had no statistical significance ( P ＞ 0.05 ). There was significant difference between the two groups in the occurrence of MACE within 6 month follow-up (2/46,4.35％ vs 9/52,17.30％ )(P ＜0.05). Conclusion Intracoronary injection of tirofiban during PCI in the intervention therapy for AMI can improve postoperative TIMI of IRA and myocardial perfusion as well as the clinical prognosis.
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