替羅非班對急性心肌梗死患者急診PCI治療療效的影響

【關鍵詞】  心肌梗死    冠狀動脈介入治療   血管成形術   替羅非班   改善微血管灌注   【摘要】 目的探討急性心肌梗死（AMI）患者急診冠狀動脈介入治療（PCI）不同時間應用替羅非班PCI療效的差別。方法選擇急診入院的60例AMI患者隨機分爲早期治療組（n=30）與晚期治療組（n=30），早期治療組於急診入院即刻靜脈給予替羅非班；晚期治療組於冠狀動脈造影后靜脈給替羅非班。比較兩組患者PCI術前後的TIMI血流分級、TIMI心肌灌注分級（TIMI myocardial perfusion grade, TMPG）、血小板聚集率及出血情況。記錄住院期間及隨訪3個月時的主要心血管事件（心源性死亡、非致死性心肌梗死及再發性心絞痛、主要心臟不良事件）的發生率。結果 （1） 術前TIMI前向血流達到3級的比例：早期治療組明顯高於晚期治療組；術後兩組差異無統計學意義。（2） 術前和術後的TMPG 23級比例：早期治療組均顯著高於晚期治療組。（3） 術後血小板聚集率：兩組患者均較術前明顯下降，兩組之間差異無統計學意義。結論 AMI 患者入院時儘早應用替羅非班對急診PCI治療是安全有效的，且能夠更明顯改善靶血管前向血流TIMI分級及心肌灌注TMPG分級。     Effect of Tirofiban on primary emergency percutaneous coronary intervention result in patients with acute myocardial infarction    CHEN Yushan, LIU Peng, ZHANG Yan, GUAN Huaimin. Department of Cardiology, Henan Provincial Chest Hospital, Zhengzhou 450008, China     Abstract：Objective  To evaluate the effect of Tirofiban on primary emergency percutaneous coronary intervention (PCI) result in patients with acute myocardial infarction (AMI).  Methods  Sixty AMI patients on admission in emergency room were divided into two groups: early group (receive Tirofiban on admission) and late group (receive Tirofiban after angiography). TIMI grade, TIMI myocardial perfusion grade (TMPG), platelet aggregation rate and bleeding in both groups were observed and compared before and after PCI. Adverse cardiovascular events were also recorded in hospital and during 3 months’ followup.  Results  Before PCI, TIMI 3 flow rate was significantly higher in early group than in late group. However, TIMI 3 flow rate after PCI was not significantly different between early group and late group. TMPG 2～3 rate was higher in early group than in late group, whether compared before PCI or after PCI. Platelet aggregation rate after PCI was lower than before PCI in both groups, there was no difference between groups.  Conclusions  Early use of Tirofiban could significantly improve forward blood flow in target vessels. It is effective and safe in AMI patients treated with primary PCI.     Key words：  Myocardial infarction;  Angioplasty;  Tirofiban     急性ST 段擡高型心肌梗死（STelevation myocardial infarction，STEMI) 是在冠狀動脈粥樣硬化、斑塊破裂的基礎上形成血栓,使冠狀動脈急性閉塞所致的臨牀綜合徵。急診經皮冠狀動脈介入術(percutaneous coronary intervention，PCI) 能使相應心肌組織儘早恢復。血小板膜糖蛋白GPⅡb/Ⅲa受體拮抗劑通過阻斷纖維蛋白原受體與GPⅡb/Ⅲa 複合物結合,抑制血小板聚集的最後通路,有效地抑制血小板聚集, 而發揮抗血栓作用，減少PCI術中的冠狀動脈血栓負荷，改善心肌灌注。本研究旨在探討早期應用替羅非班對STEMI患者急診PCI治療的影響。         文章來源：
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