替罗非班治疗老年人急性冠状动脉综合征的疗效分析

Objective To explore the curative effect of tirofiban treatment on high-risk acute coronary syndromes (ACS) in elderly patients receiving an early percutaneous coronary intervention (PCI) treatment. Methods The 162 elderly cases including unstable angina pectoris and non-ST -segment elevation myocardial infarction (NSTEMI) undergoing early PCI were enrolled in this study.And they were assigned to early treatment group (n=82) and deferred selective group (n=80)according to the time of using tirofiban (Gp Ⅱ b/Ⅲ a inhibitor) treatment. The effectiveness of either strategic option on tissue-level perfusion was evaluated using the TIMI myocardial perfusion grade (TMPG) before and immediately after PCI. The corrected TIMI frame count (cTFC) was also used to assess coronary artery flow and myocardial perfusion. Bleeding complications and the composite end point events at 30 days were also evaluated. Results Of all the 162 patients, the TMPG 0-1 perfusion was observed in 65 patients (40.1%). The TMPG 0-1 perfusion was significantly less frequent in early treatment group (32.9%) than in deferred selective group (47.5%) before PCI (x2=3.58, P＜0.05); while the results of TIMI grade 0-1 flow (26.8% vs. 25.0%) and cTFC levels (34.2±11.8 vs. 34. 9±12. 7) before PCI were similar between the two groups (x2 =0. 07, P=0.47; t= 0.13, P=0.71, respectively). No differences were seen both in composite end point events at 30 days and bleeding complications (x2 = 0.31, P＞0.05; x2=0.004, P＞0. 05). Conclusions High -risk ACS patients treated with an early invasive strategy, routine upstream use of tirofiban are associated with improved tissue-level perfusion before PCI and does not increase bleeding complications when bleeding risks are carefully evaluated before enrollment.     

替罗非班治疗老年人急性冠状动脉综合征的疗效分析

目的 探讨早期介入治疗的老年高危急性冠状动脉综合征(ACS)患者应用替罗非班的疗效分析. 方法 选择接受早期冠状动脉介入治疗(PCI)的老年不稳定型心绞痛和(或)非ST段抬高心肌梗死(UA/NSTEMI)患者162例,按替罗非班使用时间分常规早期治疗组(82例)和延期选择性治疗组(80例),分别评估两种治疗方案对PCI术前、术后即刻冠状动脉血流、心肌组织水平灌注和30 d复合心血管事件等观察指标的影响. 结果 PCI术前心肌梗死溶栓试验(TIMI)血流心肌灌注分级(TMPG)0～1级共65例(40.1%),其中早期治疗组27例(32.9%),延期治疗组38例(47.5%),早期治疗组PCI术前TMPG分级0～1级发生率低于延期治疗组(x2=3.58,P＜0.05);两组PCI术前TIMI 0～1级血流[22例(26.8%)和20例(25.0%)]、术后即刻TIMI 3级血流[80例(97.6%)和77例(96.3%)]及术前、术后校正的TIMI血流计帧数分别为(34.2±11.8)帧和(34.9±12.7)帧、(23.1±4.6)帧和(22.6±3.8)帧,差异无统计学意义(x2值分别为0.07、0.23、0.49;t值分别为0.13、0.57,均P＞0.05);30 d复合心血管事件及出血发生率两组差异无统计学意义(x2值分别为0.31、0.004,均P＞0.05). 结论 替罗非班早期治疗老年高危ACS患者能改善PCI术前心肌微循环,提高组织水平灌注.     

缺血后处理对改善老年人急性心肌梗死再灌注损伤心肌血流灌注的疗效分析

目的 探讨缺血后处理对老年急性ST段抬高型心肌梗死(STEMI)患者再灌注损伤的保护作用。 方法 连续选择发病12h内行直接经皮冠状动脉介入治疗(PCI)的急性STEMI患者215例,数字抽签法随机分为缺血后处理组和常规治疗组（对照组）,两组年龄65岁及以上患者分别为38例和46例。对照组给予单纯再灌注治疗,缺血后处理组采用再灌注30 s,再缺血30 s,交替3次后再持续灌注的方法。分别评估缺血后处理对老年患者再灌注心律失常的发生率、冠状动急性心肌梗死溶栓试验(TIMI)血流分级和心肌组织水平灌注等指标的影响。 结果 缺血后处理组和对照组再灌注心律失常发生率分别为21.1％(8/38)和45.7％(21/46),差异有统计学意义(x2=5.571,P＜0.05);其中高危、需要药物或电转复及临时起搏等干预的心律失常发生率分别为7.9％(3/38)和26.1％(12/46),差异有统计学意义(x2=4.695,P＜0.05)。校正的TIMI血流帧数(cTFC)分别为(23.6±3.7)帧和（26.1±5.9）帧(t=5.434,P＜0.05)。TIMI心肌灌注分级(TMPG)3级分别为89.5％（34例）和69.6％（32例）,差异有统计学意义（x2=4.899,P＜0.05）。 结论 心肌缺血后处理能减轻老年STEMI患者心肌再灌注损伤,可应用于老年人STEMI再灌注损伤的防治。     

糖蛋白Ⅱb/Ⅲa受体拮抗剂治疗高危急性冠脉综合征的应用时限研究

目的:探讨接受早期介入治疗的高危急性冠脉综合征(ACS)患者,血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂的最佳应用时机.方法:选择接受早期冠脉介入治疗(PCI)的高危不稳定型心绞痛/非ST段抬高心肌梗死(UA/NSTEMI)患者162例,接替罗非班使用时机分常规早期治疗绀和延期选择性治疗组,分别评估两种治疗方案对PCI术前、术后心肌组织水平灌注和30天复合心血管事件发生率的影响.结果:PCI术前TMPG分级0～1级患者共65例(40.1%),其中早期治疗组27例(32.9%),延期治疗组38例(47.5%);统汁显示早期治疗组PCI术前TMPG分级0～1级发生率显著低于延期治疗组(P<0.05).30天复合心血管事件及出血发生率两组无差异(P>0.05).结论:GP Ⅱb/Ⅲa拈抗剂早期治疗能改善PCI术前肌微循环,提高组织水平灌注.