替罗非班治疗高危非ST 段抬高急性冠状动脉综合征的疗效及对 血浆脑钠肽含量的影响

目的观察替罗非班治疗高危非ST段抬高急性冠状动脉综合征(ACS)的疗效和安全性,以及对血浆脑钠肽(BNP)含量的影响。方法 180例高危ACS患者随机分为观察组和对照组,对照组90例给予阿司匹林、氯吡格雷、低分子量肝素等常规治疗,观察组90例在常规治疗基础上加用替罗非班,负荷量0.4μg·kg-1·min-1×30min,然后0.01μg·kg-1·min-1微量泵静脉泵入,疗程48～72h。结果 72h内观察组死亡、新的心肌梗死、顽固性缺血和30d内观察组死亡、新的心肌梗死的发生率与对照组比较差别均无统计学意义(P>0.05)。观察组30d内复合终点事件及顽固性缺血的发生率较对照组显著降低(P<0.01),血小板聚集率明显下降(P<0.01)。2组出血发生率比较差别无统计学意义(P>0.05)。72h及30d观察组BNP浓度较对照组明显降低,差别有统计学意义(P<0.05)。结论在常规药物基础上加用替罗非班治疗高危非ST段抬高ACS是安全且有效的。

Effect of tirofiban on high-risk non-ST-segment elevation acute coronary syndrome and influence on the brain natriuretic peptide levels

Objective To investigate the efficacy and safety of tirofiban in the treatment of high-risk non-ST-segment elevation of acute coronary syndrome ( ACS) ,and its effect on the content of brain natriuretic peptide( BNP). Methods One hun-dred and eighty cases of patients with high-risk ACS were randomly divided into observation group and control group. Both groups were given conventional treatment,which included aspirin,clopidogrel,and low molecular weight heparin and so on. The observation group was given tirofiban ( loading dose 0. 4 μg·kg -1 ·min -1 for 30 minutes; and 0. 01 μg·kg -1 ·min -1 micro pump in-travenous injection for 48 -72 hours). Results The diferences btween the incidence rate of death,new myocardial infarction and refractory ischemia in 72 hours in observation group and that in 3 days in control group were not statistically significant( P > 0. 05). The incidence of composite end-point events and refractory ischemia in 30 days were significantly reduced in the observation group compared with control group( P < 0. 01) ,and the platelet aggregation rate also decreased significantly( P < 0. 01). There was no significant difference in the incidence of bleeding between two groups( P > 0. 05). The BNP concentration in treatment group in 72 hours and 30 days were significantly decreased compared with control group,and the difference was statistically significant ( P < 0. 05). Conclusion Additional use of tirofiban on the basis of conventional drug is safe and effective in the treatment of high-risk non-ST-segment elevation of ACS.