替罗非班治疗难治性不稳定型心绞痛的临床观察

目的观察替罗非班治疗不稳定型心绞痛的疗效及安全性。方法将65例患者随机分为观察组和对照组，两组均应用阿司匹林、氯吡格雷、低分子肝素及抗缺血药物，观察组在此基础上加用替罗非班治疗，替罗非班以负荷量0．4μg／（kg·min），30min内微量泵泵人，继以维持量0．1μg／（kg·min）微量泵泵入48h。观察两组用药前后心绞痛发作情况、心电冈、血小板、凝血功能（APTT）、肌钙蛋白T及主要出血不良反应。结果与对照组比较，观察组在心绞痛症状缓解、心电图ST—T改变方面有明显改善，临床总有效率（96．97％）与对照组（75．00％）比较，差异有统计学意义（P〈0．05），两组治疗前后及两组治疗后比较血小板数目未见明显变化（P〉0．05）。观察组治疗48h后较治疗前、治疗2周后及对照组治疗前后APTT延长，差异有统计学意义（P〈0．05）。治疗48h后观察组肌钙蛋白T较对照组明显降低，差异有统计学意义（P〈0．05），在m血等不良反应方面两组间无明显差异。结论替罗非班是治疗难治性不稳定型心绞痛有效安全的药物。

Clinical observation of tirofiban in the treatment of refractory unstable angina pectoris

Objective To observe the effect and security of tirofiban in the treatment of unstable angina pectoris. Methods Sixty-five patients were randomly divided into observation group and control group. Aspirin, clopidogrel, low molecular weight heparin and anti-ischemic agent were used in both groups. Observation group added tirofiban with loading dose of 0.4 μg/（kg＇min） pumped with a micro-infusion pump within 30 minutes, and then pumped with a maintenance dose of 0.1 μg/（kg＇min） for 48 hours. Two groups were observed with anginal frequency before and after treatment, electrocardiogram, blood platelet, blood coagulation （AfrIT）, cardiac troponin T and major adverse reactions such as bleeding. Results Compared with control group, the observation group had obviously improved in relieving angina pectoris and the change of ST-T in electrocardiogram. The total clinical effective rate was 96.97%, compared with control group （75.00%）, the difference was statistically significant （P 〈 0.05）. The platelet count had no significant change before and after treatment in two groups （P 〉 0.05）. The APTT of observation group 48 h after treatment was longer than that before treatment and 2 weeks after treatment, also longer than that of control group before and after treatment, the difference was statistically significant （P 〈 0.05）. 48 hours after treatment, troponin T of observation group was obviously lower than that in control group, the difference was statistically significant （P 〈 0.05）. There was no significant difference between two groups in bleeding and other adverse reaction. Conclusion Tirofiban is an effective and safe drug in the treatment of refractory unstable angina pectoris.