替罗非班对急性ST段抬高心肌梗死伴呕吐患者血小板聚集率的影响

目的 拟对急性ST段抬高心肌梗死伴呕吐患者,应用替罗非班弥补由于呕吐而导致的抗血小板药物摄入不足,进而探讨替罗非班对患者血小板聚集率的影响.方法 2009年12月至2011年12月南开医院心内科收治的,急性ST段抬高心肌梗死并接受急诊经皮冠状动脉介入治疗（PCI）的患者287例,其中服用双联抗血小板药物时发生呕吐者66例（23.0％）.将66例患者随机分为替罗非班组（33例）和常规治疗组（33例）.替罗非班组：呕吐后立即使用替罗非班静脉推注10μg/kg,继以0.15 μt/ （kg· min）滴注,持续24～36 h];常规组：不使用替罗非班.所有患者在PCI术后12～24 h使用血栓弹力图（TEG）仪测定血小板聚集率.结果 替罗非班组比常规组血小板功能花生四烯酸（AA）抑制率（77.59±11.11）％比（52.48±12.06）％,P＜0.001]、腺苷二磷酸（ADP）抑制率（75.69±12.30）％比（49.54±14.13）％,P＜0.001]均显著升高,而血栓形成的最大幅度（MA）值则显著下降（22.79±4.19） mm比（36.28±6.08） mm,P＜0.001].结论 急性ST段抬高心肌梗死伴呕吐患者应用替罗非班可显著增强血小板抑制率,在此类高危患者中加用血小板糖蛋白Ⅱ b/Ⅲ a抑制剂类药物,能显著扭转因呕吐所致的抗血小板药物剂量不足诱发的血小板聚集抑制率减低.

Impact of tirofiban on platelet aggregation rate in patients with ST-segment elevation myocardial infarction and vomiting

Objective To evaluate the effect of additional tirofiban on the platelet function in patients with ST-segment elevation myocardial infarction（STEMI） who vomited after receiving the loading doses of aspirin and clopidogrel.Methods A total of 287 patients with STEMI admitted to Tianjin Nankai Hospital and received primary percutaneous coronary intervention from Dec 2009 to Dec2011.Among them,66 （23.0％） patients had vomiting after taking the loading doses of aspirin and clopidogrel.These 66 patients were randomly divided into 2 groups：Tirofiban group n=33,10 μg/kg injected intravenously,then 0.15 μg/（kg℉min） infused intravenously for 24-36 h] ; and standard group （n=33）.All patients received the platelet function test with thrombelastography （TEG）12-24h after the primary PCI.Results Compared with the standard group,the tirofiban group showed significantly higher platelet function inhibition rates of arachidonic acid （AA） （77.59±11.11）％ vs.（52.48±12.06）％,P ＜ 0.001）],and adenosine diphosphate （ADP） inhibition ratio （75.69±12.30）％ vs.（49.54±14.13）％,P ＜ 0.001）],but a significantly lower MA （22.79±4.19） mm vs.（36.28±6.08） mm,P ＜ 0.001）].Conclusions Additional Tirofiban in patients with STEMI who vomited after receiving the loading doses of dual antiplatelet therapy showed significant beneficial effects on the inhibition of platelet function after primary PCI,suggesting it might be a suitable treatment for this subset of patients.