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主管单位:
上海市卫生健康委员会
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CN31-1366/R
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替罗非班不同给药方式对急性心肌梗死再灌注及疗效的影响

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DOI:
作者:
汪志华，金惠根，刘宗军，郜俊清，于宏梅，汪蔚青，杨伟，沈峻
Wang Zhihua, Jin Huigen, Liu Zhongjun, Gao Junqing
作者单位:
普陀区中心医院
putuo central hospital
关键词:
替罗非班 急性ST抬高心梗 急诊PCI 心肌灌注分级
tirofiban acute STEMI primery PCI TMP
摘要:
目的 探讨急诊PCI前不同方式应用替罗非班（欣维宁）对梗死相关血管（IRA）及疗效的影响。方法 172例急性ST段抬高心梗随机分为三组：A组（61例），术前基础用药：阿司匹林300mg、氯吡格雷300mg顿服；B组（56例），基础用药加用静脉滴注替罗非班（欣维宁）300-400ug/h；C组（55例），在B组基础上再静脉推注替罗非班（欣维宁）10ug/kg。对即刻疗效（梗死血管的自溶率、术中无复流及ST段回落）及住院期间临床事件（心衰、大出血、死亡）进行对比。结果 急诊造影发现A、B、C三组的梗死相关血管自溶率(31.15vs41.17vs72.73)及ST段回落(75.41vs87.5vs94.55)均有显著性差异(P<0.05)；术中B、C两组无复流发生略低于A组（4vs2vs9 P=0.093）。三组住院期间临床事件：心衰、大出血、死亡无显著性差异。结论 急诊PCI术前静脉推注替罗非班能显著减少急性ST段抬高心梗患者的血栓负荷，明显增加患者梗塞血管的自溶率，减少术中无复流的发生。
【Abstract】 Objective To investigate the infarct-related artery(IRA) and the curative effect by different ways of application of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty. Methods 172 patients with acute ST-segment elevation myocardial infarction were randomly divided into three groups: A group (61 cases), Preoperative medication : aspirin 300mg, clopidogrel 300mg dayton suits; B group (56 cases), intravenous infusion of tirofiban (Tirofiban) 300-400ug / h on the basis of the A group; C group (55 cases), Intravenous bolus tirofiban 10ug/kgthe on the basis of B group. Immediate effect (self-dissolution rate of infarct vessel%, no reflow%、 ST segment resolution% and TIMI myocardial perfusion) and clinical events during hospitalization (heart failure, hemorrhage, death) were compared. Results Emergency angiography found that the dissolution rate (31.15%vs41.17%vs72.73%) and ST segment resolution (75.41%vs87.5%vs94.55%) of the infarct-related artery in A, B, C three groups were significantly different (P <0.05). We found in intraoperative that in B, C groups, no-reflow occurred slightly lower than A group (4vs2vs9 P = 0.093). The clinical events of three groups during hospitalization: heart failure, hemorrhage, death was no significant difference. Conclusion Preoperative intravenous bolus of tirofiban can significantly reduce the thrombotic burden in patients with acute ST-segment elevation myocardial infarction, increased the autolysis rate of the infarct vessel, reduce the occurrence of no-reflow.

 

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