急诊冠状动脉介入治疗患者早期应用替罗非班的疗效及安全性观察

摘要

Objective To investigate the clinical efficacy and safety of tirofiban administrated before emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods STEMI patients with PCI (n=134) were chosen from Jan. 2012 to Dec. 2013, and randomly divided into observation group (n=69) and control group (n=65). The outcomes of coronary angiography (CAG), TIMI flow, sumSTR of electrocardiogram (ECG), incidence of major adverse cardiovascular events (MACE) within 1 w after hospitalization and 90 d after PCI, LVEF, platelet count (PLT) and incidence bleeding events before and 24 h and 1 w after PCI were compared between 2 groups. Results The difference in general clinical data and CAG outcomes had no statistical significance (all P>0.05) between 2 groups. The proportion of patients with grade III TIMI flow after PCI was higher in observation group than that in control group (97.1%vs. 92.3%, P>0.05), while proportion of patients with sumSTR>50%after PCI for 90 min was significantly higher in observation group than that in control group (94.2%vs. 80.0%, P<0.05). The incidence of refractory angina pectoris and MACE decreased significantly in observation group compared with control group (2.9%vs. 13.8%, 4.3%vs. 15.4%, all P<0.05) within 1 w after hospitalization. The incidence of MACE had no significant changes after PCI for 90 d (1.4%vs. 3.1%), and LVEF [(53.86±4.50)%vs. (52.03±4.10)%] increased significantly in observation group compared with control group (P<0.05). PLT and incidence bleeding events before and 24 h and 1 w after PCI had no statistical difference between 2 groups (all P>0.05). Conclusion Early administration of tirofiban can significantly promote the perfusion of myocardial cells and microcirculation, and improve left cardiac function and clinical prognosis without increasing bleeding risks.%目的：探讨急诊经皮冠状动脉介入（PCI）治疗术前采用替罗非班治疗急性ST段抬高型心肌梗死（STEMI）患者的临床疗效及安全性。方法择2012年1月至2013年12月在山西省心血管病医院CCU住院并行急诊PCI治疗的STEMI患者共计134例。随机分为观察组（69例）和对照组（65例）。比较两组患者冠状动脉造影情况、术后TIMI血流、心电图ST段抬高总和回落百分比（sumSTR）、住院期间1周内和术后90天主要不良心脏事件的发生率、左室射血分数（LVEF）、术前和术后24h及1周血小板计数、出血事件的发生率。结果两组间一般临床资料、冠状动脉造影情况差异均无统计学意义（P均＞0.05）。观察组术后TIMI血流Ⅲ级的比例高于对照组，但差异无统计学意义（97.1% vs.92.3%，P＞0.05），而术后90分钟sumSTR＞50%的比例观察组明显高于对照组，差异有统计学意义（94.2% vs.80.0%，P＜0.05）；观察组住院期间1周内顽固性心绞痛及主要不良心脏事件（MACE）的发生率（2.9%vs.13.8%,4.3%vs.15.4%，P均＜0.05）明显降低，术后90天MACE的发生率较对照组无明显变化（1.4%vs.3.1%），而LVEF[（53.86±4.50）%vs.（52.03±4.10）%，P＜0.05]显著提高。两组患者术前和术后24h、1周血小板计数以及出血事件的发生率相比，差异均无统计学意义（P均＞0.05）。结论早期应用替罗非班可显著提高STEMI患者的心肌细胞灌注，改善微循环，从而改善左心功能和临床预后，且并未增加出血风险。