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急诊经皮冠状动脉介入治疗术中冠状动脉内注射盐酸替罗非班对急性ST段抬高型心肌梗死患者心肌灌注及心功能的影响
引用本文:马东星,刘惠亮,姚宏英,穆雷,吴晓霞,韩玮,杨胜利,罗建平.急诊经皮冠状动脉介入治疗术中冠状动脉内注射盐酸替罗非班对急性ST段抬高型心肌梗死患者心肌灌注及心功能的影响[J].中国全科医学,2010,13(5):476-478.
作者姓名:马东星  刘惠亮  姚宏英  穆雷  吴晓霞  韩玮  杨胜利  罗建平
作者单位:武警总医院心内科,北京市,100039
摘    要:目的探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)时冠状动脉(冠脉)内注射负荷剂量盐酸替罗非班对心肌灌注及心功能的影响。方法选择2007年7月—2008年12月我科确诊STEMI并接受急诊PCI患者70例,随机分为观察组(36例)和对照组(34例)。两组患者均进行PCI,术中观察组患者给予盐酸替罗非班10μg/kg冠脉内注射,对照组给予等量0.9%氯化钠注射液冠脉内注射。比较两组患者PCI术后即刻造影结果,术后7、30、180 d的左室射血分数(EF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)及术后180 d主要不良心血管事件(MACE)发生率,同时观察住院期间的出血并发症。结果观察组患者术后校正TIMI帧数、术后2 h ST段回落程度、磷酸肌酸激酶同工酶(CK-MB)峰值及峰值时间均优于对照组,差异有统计学意义(P〈0.05);梗死相关血管无复流发生率及术后180 d MACE(包括死亡、再梗死、再次靶血管重建)发生率显著低于对照组,差异有统计学意义(P〈0.05);与对照组比较,观察组术后7、30、180 d的EF显著增加,LVEDD、LVESD显著降低,差异有统计学意义(P〈0.05)。两组住院期间出血并发症的发生率间差异无统计学意义(P〉0.05)。结论对于STEMI患者行急诊PCI术中联合冠脉内注射替罗非班治疗可减少无复流、慢血流现象的发生,改善心肌水平再灌注状态和左室功能,同时不增加出血发生率,有利于提高临床预后。

关 键 词:心肌梗死  心肌再灌注  替罗非班  血管成形术  经腔  经皮冠状动脉

Effects of Intracoronary Tirofiban Injection on Myocardial Perfusion and Near-Future Cardiac Function in STEMI Patients in Emergency Percataneous Coronary Artery Intervention
MADong-xing,LIUHui-liang,YAOHong-ying,etal.Effects of Intracoronary Tirofiban Injection on Myocardial Perfusion and Near-Future Cardiac Function in STEMI Patients in Emergency Percataneous Coronary Artery Intervention[J].Chinese General Practice,2010,13(5):476-478.
Authors:MADong-xing  LIUHui-liang  YAOHong-ying  etal
Institution:MA+Dong-xing,LIU+Hui-liang,YAO+Hong-ying,et+al.Department+of+Cardiology,General+Hospital+of+Chinese+Armed+Police+Force,Beijing+100039,China
Abstract:Objective To study the effects of primary percutaneous coronary intervention combined with tirofiban therapy on myocardial perfusion and clinical outcomes in STEMI patients in emergency percataneous coronary intervention(PCI).Methods Seventy STEMI patients receiving emergency PCI were divided randomly into groups tirofiban (n=36) and control (n=34).During PCI,tirofiban group were given intracoronary Tirofiban injection,10 μg/kg,and control group intracoronary 0.9% sodium chloride injection in the same dose.The postoperative immediate visualization results,left ventricular ejection fraction (EF),left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) on days 7,30,180 after intervention,major adverse cardiac events (MACE) on days 180 were compared between 2 groups,and the bleeding complications were observed during hospitalization.Results The tirofiban group were superior to control group in corrected TIMI frame count,falling degree of ST-segment elevation 2 h after operation,CK-MB peak and peak time,and in EF,LVEDD,LVESD on days 7,30,180,the difference was significant (P<0.05).The incidences of infarct-related artery no-reflow and of MACE (including death,reinfarction,target vessel re-reconstruction) 180 d after operation were lower in tirofiban group than in control,the difference was significant (P<0.05).No significant difference was noted in incidence of bleeding complications between 2 groups during hospitalization (P>0.05).Conclusion Emergency PCI combined with intracoronary tirofiban injection,reducing the incidence of no-reflow slow flow and improving myocardial reperfusion and left ventricular function without increasing bleeding incidence,is beneficial to clinical prognosis improvement.
Keywords:Myocardial infarction  Myocardial reperfusion  Tirofiban  Angioplasty  transluminal  percutaneous coronary
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