冠状动脉内注射不同剂量替罗非班对老年ST段抬高型心肌梗死患者急诊介入术后近期预后的影响

摘要

目的 探讨不同剂量血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班在ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)中应用的安全性和近期预后.方法 入选2011年3月-2012年6月辽宁医学院附属第三医院收治的86例老年STEMI患者,根据PCI冠状动脉内应用替罗非班的剂量分为大剂量组(n=48)和常规组(n=38),观察两组患者术后TIMI血流分级、ST段抬高总和回落百分比、血N-末端脑钠肽前体(NT-proBNP)水平的变化;住院期间和随访1个月时的左室射血分数(LVEF)、主要心血管事件发生率及出血事件发生率.结果 大剂量组较常规组有较高的TIMI3级血流获得率(81.25% vs.57.89%),差异有统计学意义(P=0.018);大剂量组术后心电图ST段抬高总和回落百分比＞50%率较常规组增高(83.33% vs.63.17%),差异有统计学意义(P=0.033);大剂量组术后第7天NT-proBNP水平较常规组降低[(994±543)μg/L vs.(1 325±791)μg/L],差异有统计学意义(P=0.024);大剂量组术后1个月LVEF较常规组升高[(57.8±11.9)% vs.(52.1±11.5)%],差异有统计学意义(P=0.027);大剂量组住院期间和随访1个月时主要心血管事件发生率较常规组降低,差异有统计学意义(P=0.032).结论 大剂量应用血小板GPⅡb/Ⅲa受体拮抗剂替罗非班对改善STEMI患者急诊PCI术后血流再灌注及近期临床预后具有积极作用,可进一步改善心肌微循环的灌注.%Objective To investigate the safety and short - term results after the intracoronary use of different doses of Tirofiban, a platelet glycoprotein Ⅱb/ Ⅲ a receptor antagonist, in ST - segment elevation myocardial infarction patients who were treated by percutaneuos coronary intervention ( PCI). Methods A total of 86 elderly patients with STEMI who were treated by emergency PCI were divided into high - dose group ( n =48 ) and conventional - dose group ( n = 38 ) from March 2011 to June 2012 in the Third Affiliated Hospital of Liaoning Medical University. The TIMI flow grade, the descended percentage of the total ST - segment elevation, and blood NT - proBNP level were observed. The changes of left ventricular ejection fraction, cardiovascular events, and bleeding were observed during hospitalization and one month after PCI. Results High - dose group showed significantly higher TIMI3 flow degree than that of conventional - dose group ( 81. 25% vs. 57. 89% , P = 0. 018 ). Compared with conventional - dose group, the descended percentage of the postoperative total ST - segment elevation > 50% was significantly higher ( 83. 33% vs. 63. 17% , P =0. 033 ), although the NT - proBNP was significantly lower after PCI in high - dose group than that of conventional - dose group [ (994 ±543) μg/L vs. (1325 ±791) μg/L, P =0.024]. Furthermore, the high-dose group had significantly higher LVEF than that of conventional - dose group [ ( 57. 8 ±11.9 )% vs. ( 52. 1 ± 11. 5 )% , P = 0. 027 ]. The cardiovascular events in high - dose group was less frequent during hospital stay and one month after PCI ( P = 0. 032 ). Conclusion Intracoronary application of high - dose Tirofiban during primary PCI in STEMI patients is safe and effective in improving blood flow perfusion and clinical prognosis.