目的 分析急性ST段抬高型心肌梗死(STEMI)急诊尿激酶溶栓后加用替罗非班或比伐芦定抗血小板治疗的作用及安全性.方法 回顾性选取180例STEMI患者,根据治疗方法不同分为三组:对照组(常规尿激酶溶栓,n=60)、替罗非班组(加用盐酸替罗非班,n=60)及比伐芦定组(加用比伐芦定,n=60).统计三组患者梗死血管再通率,评估抗血小板作用,并统计治疗期间出血及心血管不良事件发生情况.结果 替罗非班组、比伐芦定组60min、90min、120min冠状动脉再通率比较差异无统计学意义(P>0.05),但两组三个时段冠状动脉再通率均显著高于对照组,差异有统计学意义(P<0.05).三组治疗前血小板参数及凝血活酶时间(APTT)比较差异无统计学意义(P>0.05),治疗后其均较治疗前显著改善,差异有统计学意义(P<0.05).替罗非班组、比伐芦定组血小板计数(PLT)、APTT升高幅度显著高于对照组,血小板平均容积(MPV)、血小板分布宽度(PDW)降低幅度显著低于对照组,差异有统计学意义(P<0.05),但两组血小板参数及APTT比较差异无统计学意义(P>0.05).三组出血分级分布及出血率比较差异均无统计学意义(P>0.05).替罗非班组、比伐芦定组心血管不良事件发生率为10.00%、8.33%,差异无统计学意义(P>0.05),但均明显低于对照组的25.00%,差异有统计学意义(P<0.05).结论 STEMI急诊尿激酶溶栓后加用替罗非班或比伐芦定抗血小板治疗均可显著提高梗死血管的再通率,改善血小板功能,降低不良心血管事件发生率,且不增加出血风险.%Objective To evaluate the efficacy and safety of antiplatelet therapy with tirofiban or bivalirudin in acute st segment elevation myocardial infarction( STEMI) after emergency urokinase thrombolysis. Methods 180 patients with STEMI were selected retrospectively and divided into three groups according to different treatment methods:control group ( routine urokinase thrombolytic therapy,n=60),tirofiban group(plus tirofiban hydrochloride,n=60)and bivalustine group(plus bivalirudin,n=60). The recanalization rate of infarct blood vessel,the antiplatelet effect and the occurrence rate of hemorrhage and adverse cardio-vascular events of patients in the three groups were analyzed. Results There was no significant difference in recanalization rate of coronary artery at 60min,90min and 120min between tirofiban group and bivalirudin group(P>0. 05),but the recanalization rate of coronary artery in the two groups at three different periods was significantly higher than that in the control group ( P<0. 05 ) . There was no significant difference in platelet parameters and thromboplastin time( APTT) between the three groups before treatment( P>0. 05). After treatment,they were all significantly improved compared with before treatment,and the difference was statistically signifi-cant(P<0. 05). In tirifiban group and bivalirudin group,the increase of the platelet count(PLT)and APTT were significantly higher than those in control group,while the decrease of the mean platelet volume( MPV) and the platelet distribution width( PDW) were sig-nificantly lower than those in the control group(P<0. 05),but there was no significant difference in platelet parameters and APTT between the two groups(P>0. 05). There was no significant difference in bleeding grade distribution and bleeding rate among the three groups(P>0. 05). The incidence of adverse cardiovascular events in the tirofiban group and the bivalirudin group was 10. 00%and 8. 33% respectively,no significant difference between them(P>0. 05),but they were significantly lower than those in the control group(25. 00%,P<0. 05). Conclusion The antiplatelet therapy with tirofiban or bivalirudin in STEMI after emergency urokinase thrombolysis can significantly improve the reperfusion rate of infarcted blood vessels,improve platelet function,reduce the incidence of adverse cardiovascular events,and do not increase the risk of bleeding.
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