急诊介入治疗急性ST段抬高型心肌梗死应用替罗非班的临床观察

目的 探讨急性ST段抬高型心肌梗死患者急诊介入治疗中应用替罗非班的有效性和安全性.方法 接受急诊经皮冠状动脉介入疗法（PCI）治疗的急性ST段抬高型心肌梗死患者96例,按治疗方法分为治疗组和对照组,每组48例,治疗组在常规标准治疗的基础上采用替罗非班治疗,冠状动脉内注射替罗非班10 μg/kg,继之以0.15μg/（kg·min）静脉泵入24 ～ 48 h,对照组采用常规标准治疗.比较两组术后60 min心电图ST段回落率,冠状动脉血流TIMI分级,术后4周主要心脏不良事件（心绞痛、心肌梗死、心力衰竭、死亡）及出血发生情况.评价两种治疗方法的效果.结果 治疗组术后60 min ST段完全回落45例（93.8％,45/48）,对照组为35例（72.9％,35/48）,两组比较差异有统计学意义（P＜0.05）;梗死血管TIMI血流≥3级的发生率治疗组为95.8％（46/48）,对照组为75.0％（36/48）,两组比较差异有统计学意义（P＜0.05）;术后4周主要心脏不良事件发生率低于对照组,差异有统计学意义（P＜0.05）,两组出血发生率比较差异无统计学意义（P＞0.05）.结论 急性ST段抬高型心肌梗死患者急诊介入治疗术中应用替罗非班安全有效.

Clinical observation of tirofiban for emergency interventional therapy in patients with acute ST segment elevation myocardial infarction

Objective To investigate the efficacy and safety of tirofiban for emergency interventional therapy in patients with acute ST segment elevation myocardial infarction.Methods The 96 acute ST segment elevation myocardial infarction patients having accepted emergency percutaneous coronary intervention （PCI） were divided into treatment group and control group according to the treatment method with 48 cases each.The treatment group was given conventional standard treatment combined with tirofiban treatment tirofiban intracoronary injection 10 μ g/kg and then intravenous 0.15 μ g/（kg· min） for 24-48 h].The control group was given conventional standard treatment only.The postoperative 60 min electrocardiogram ST segment recovery,the coronary blood flow TIMI grade,the major adverse cardiac events （angina,myocardial infarction,heart failure,death） and postoperative bleeding in 4 weeks were compared between the two groups.Results The patients having postoperative 60 min electrocardiogram ST segment recovery in treatment group was 45 cases （93.8%,45/48）,in control group was 35 cases （72.9%,35/48）,and there was statistical difference （P 〈 0.05）.The incidence rate of infarction vascular TIMI grade ≥ 3 grade flow in treatment group was 95.8% （46/48）,in control group was 75.0% （36/48）,and there was statistical difference （P 〈 0.05）.The incidence rate of the major adverse cardiac events 4 weeks in treatment group was significantly lower than that in control group,and there was statistical difference （P 〈 0.05）.There was no statistical difference in the incidence rate of bleeding between the two groups （P 〉 0.05）.Conclusion In patients with acute ST segment elevation myocardial infarction,the emergency interventional therapy with tirofiban is efficacy and safety.