替罗非班在老年人急诊经皮冠状动脉介入治疗中预防无复流的临床观察

目的观察老年人急诊PCI术中冠状动脉内注射替罗非班对术后无复流的影响。方法选择急性心肌梗死行急诊PCI患者163例,随机分为替罗非班组(83例)和对照组(80例)。替罗非班组在导丝通过病变后经导管冠状动脉内注射替罗非班10μg/kg,之后予替罗非班0.15μg/(kg·min)持续静脉滴注24 h。对照组给予常规治疗。观察2组患者TIMI、心肌灌注分级(TMPG),入院后30 d LVEF和左心室舒张末内径,心血管事件及出血并发症。结果替罗非班组TIMI血流3级和TMPG 2～3级比例较对照组明显升高,TIMI血流0～2级和TMPG 0～1级比例较对照组明显降低,差异有统计学意义(P<0.05)。替罗非班组LVEF较对照组明显改善,主要心血管事件较对照组明显降低,差异有统计学意义(P<0.05)。结论急诊PCI术中冠状动脉内注射替罗非班减少无复流,改善心肌灌注和心功能,且不增加心血管事件和并发症。

The effect of intracoronary tirofiban on no-reflow in elderly patients with acute myocardial infarction treated with primary PCI

Objective To investigate the effect of intracoronary tirofiban on coronary no-reflow in patients with acute ST-elevation myocardial infarction(STEMI) treated with primary PCI.Methods 163 cases of STEMI ready to receive primary PCI were randomly divided into tirofiban group (n=83) and control group(n=80).Intracoronary tirofiban bolus(10μg/kg) was administered after the guide wire passed through the lesion,followed by tirofiban0.15μg/(kg?min)]infusion for 24 hours in tirofiban group.Conventional drug treatment was given to the control group.At the end of PCI thrombolysis in myocardial infarction(TIMI) flow grade and myocardial perfusion grade(TMPG) were observed in the two groups.LVEF,left ventricular end diastolic diameter (LVEDD),the incidence of major adverse cardiac events(MACE) and bleeding complications were compared between two groups before discharge.Results Compared with control group,tirofiban group achieved higher rates of TIMI 3 flow and TMPG 2-3(P<0.05),and lower rates of TIMI 0-2 flow and TMPG 0-1 after PCI.Tirofiban group had higher LVEF and lower rate of MACE than control group before discharge(P<0.05).Conclusion Intracoronary tirofiban during primary PCI in patients with AMI can reduce no-reflow,improve myocardial perfusion and heart function,and does not increase MACE and complication.