冠状动脉内注射替罗非班治疗急性ST段抬高型心肌梗死的疗效和预后评价

目的分析急性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）术中冠状动脉（冠脉）内注射替罗非班对梗死相关血管冠脉血流（TIMI）的影响。方法 116例STEMI患者根据PCI术中是否冠脉内应用替罗非班分为常规治疗组（66例）和替罗非班组（50例）,对比2组PCI术后梗死相关血管的TIMI分级、校正的TIMI计帧数,观察2组患者出血并发症发生率、住院期间和出院后6个月主要心血管事件发生率。结果替罗非班组PCI术后TIMI 3级血流获得率明显高于常规治疗组,差异有统计学意义（98.0%vs 84.8%,P〈0.05）;校正的TIMI计帧数低于常规治疗组,差异有统计学意义〔（21.5±5.9）帧vs（29.6±6.2）帧,P〈0.01〕。术后1周替罗非班组左心室射血分数（LVEF）高于常规治疗组,差异有统计学意义（P〈0.01）;出血并发症发生率高于常规治疗组,但差异无统计学意义（P〉0.05）;6个月内主要心血管事件发生率低于对照组,差异有统计学意义（P〈0.05）。结论 STEMI介入治疗中冠脉内注射替罗非班较为安全,可以明显改善PCI术后的冠脉血流、心肌灌注及临床预后。

The therapeutic efficacy and prognosis evaluation of intracoronary injection of tirofiban in acute ST-segment elevation myocardial infarction

Objective To evaluate the effect of intracoronary injection of tirofiban on thrombolysis in myocardial infarction（TIMI） flow of infarct-related artery（IRA） in patients with ST-segment elevation myocardial infarction（STEMI） during emergency percutaneous coronary intervention（PCI）.Methods 116 STEMI patients were divided into tirofiban group（n=50） and routine group（n=66）.The TIMI grade and corrected TIMI frame count（CTFC） following PCI operation were compared,and the bleeding condition as well as major adverse cardiac events（MACE,including death,re-infarction and target vessel revascularization） in hospital and 6 months after discharge from hospital.Results There was a higher percentage of TIMI Ⅲ flow in tirofiban group following PCI（98.0% vs 84.8%,P0.05）,and fewer TIMI frames（21.5±5.9 frames vs 29.6±6.2 frames） as compared to the routine group（P0.01）;The left ventricular ejection fraction（LVEF） one week after PCI was higher in tirofiban group,with statistical difference（P0.01）;There was a higher prevalence in the complication of bleeding in tirofiban group but the difference had no statistical significance（P0.05）.There was significant difference between the two groups in the occurrence of MACE within 6-month follow-up（P0.05）.Conclusion Intracoronary injection of tirofiban during PCI in the intervention therapy for STEMI is safe and markedly improves postoperative TIMI of IRA and myocardial perfusion as well as the clinical prognosis.