冠状动脉内注射替罗非班治疗急性冠状动脉综合征介入术中无复流的有效性和安全性

目的:评价冠状动脉内注射国产盐酸替罗非班对急性冠状动脉综合征(acute coronary syndrome,ACS)介入术后无复流患者冠状动脉TIMI血流的影响及安全性。方法:将ACS患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后判定无复流者48例,随机分为替罗非班组(冠状动脉内注射维拉帕米及盐酸替罗非班10μg/kg)25例和维拉帕米组(冠状动脉内注射维拉帕米200μg)23例。观察给药后30min TIMI血流分级及校正的TIMI计帧数(CTFC),7天后左心室射血分数,出血并发症及30天内主要不良心血管事件(MACE)发生率。结果:替罗非班组介入术后无复流患者TIMIⅢ级血流获得率(64.0%)高于维拉帕米组(34.8%)(P<0.05);CTFC显示替罗非班组血流快于维拉帕米组(P<0.01);替罗非班组7天后左心室射血分数高于维拉帕米组(P<0.01);出血并发症发生率和30天内MACE发生率与维拉帕米组差异均无统计学意义(P>0.05)。结论:冠状动脉内注射国产盐酸替罗非班治疗ACS介入术后无复流患者是有效和安全的。

Efficacy and safety of intracoronary administration of tirofiban in treatment of no-reflow phenomenon after percutaneous coronary intervention for acute coronary syndrome

Objective：To evaluate the efficacy of tirofiban by intracoronary administration on TIMI flow in acute coronary syndrome（ACS） with no-reflow phenomenon after percutaneous coronary intervention（PCI）.Methods：Forty-eight ACS patients with no-reflow phenomenon after PCI were randomized to tirofiban group（intracoronary verapamil and tirofiban,10 μg/kg,n=25） and verapamil group（intracoronary verapamil,200 μg,n = 23）.The TIMI flow at 30 min post-medication,corrected TIMI frame count（CTFC）,left ventricular ejection fraction after PCI for 7 days,hemorrhage complication and incidence of major adverse cardiovascular events（MACE） within 30 days after PCI were observed in both groups.Results：The TIMI 3 ratio in tirofiban group（64.0%） was markedly higher than that in verapamil group（34.8%）（P〈0.05） ;CTFC showed that the coronary blood flow in tirofiban group was faster than that in verapamil group（P〈0.01） ;the left ventricular ejection fraction after PCI for 7 days was higher in tirofiban group than in verapamil group（P〈0.01） ;the difference between the hemorrhage complication and the incidence of MACE within 30 days after PCI was not significant（P〉0.05）.Conclusions：Intracoronary administration of tirofiban is effective and safe for ACS patients with noreflow phenomenon after PCI.