老年急性ST段抬高型心肌梗死患者急诊介入治疗中冠状动脉联合静脉内应用小剂量替罗非班的临床研究

目的探讨因急性ST段抬高型心肌梗死（STEMI）行急诊经皮冠状动脉（冠脉）介入治疗（PCI）的老年患者，冠脉联合静脉内使用d,N量替罗非班的有效性及安全性。方法选择行急诊PCI的老年STEMI患者76例，年龄≥70a，随机分为对照组和研究组，每组各38例患者。对照组：静脉内应用替罗非班负荷剂量1μg/kg，之后以0．15μg·kg-1·min-1持续静脉泵人24h；研究组：冠脉内注射负荷剂量10μg／kg，之后以0．075μg·kg-1·min。持续静脉泵人24h。比较2组PCI术后心电图sT段回落率，血清超敏肌钙蛋白T（cTnT）峰值，梗死相关动脉（IRA）血栓积分、TIMI血流分级、TIMI心肌灌注分级（TMPG），PCI术后90d左心室射血分数（LVEF）及主要不良心血管事件（MACEs）发生率的差异；比较2组用药期间出血事件发生率的差异。结果PCI术后，与对照组比较，研究组心电图ST段回落率有降低的趋势（P=0．053），血清超敏cTnT峰值（P=0．025）、IRA血栓积分显著降低（P=0．013），TIMI3级血流及TMPG3级的获得率显著增高（P值分别为0．038和0．030）。与对照组比较，研究组患者PCI术后90d的LVEF显著增加（P=0．026），总MACEs的发生率有降低的趋势（P=0．053）。用药期间，研究组总出血事件的发生率显著低于对照组（P=0．033）。结论对于行急诊PCI的老年STEMI患者，与单纯静脉内使用替罗非班相比，冠脉联合静脉内小剂量替罗非班更有助于改善冠脉血流、心肌灌注和缩小梗死面积，并显著降低出血事件的发生率。

Intracoronary Bolus Plus Administration of Tirofiban Percutaneous Coronary Elevation Intravenous Low-dose Maintenance in Aged Patients Undergoing Primary Intervention for Acute ST-segment Myocardial Infarction

Objective To investigate the efficacy and safety of intracoronary bolus plus intravenous low-dose maintenance administration of tirofiban in aged patients undergoing primary percutaneous coronary intervention （PCI） for acute ST-segment elevation myocardial infarction （STEMI）. Methods In patients of age 〉170 years old, 76 patients were divided into control （n=38） and study （n = 38） group. In the control group, tirofiban was given intravenously as a bolus （ 10μg/kg） followed by maintenance intravenous infusion at 0.15μg · kg-1· min-1 for 24 h. In the study group, tirofiban was administered as an intracoronary bolus injection （10μg/kg） followed by maintenance intravenous infusion at 0.075μg· kg-1· min-1 for 24 h. ST-segment resolution, peak concentration of serum high-sensitive cardiac troponin T （hs- cTnT）, scores of thrombus, TIMI flow grade and TMI myocardial perfusion grade in the infarct-related artery （IRA） wereanalyzed in the 2 groups. Left ventricular ejection fraction （LVEF） and major cardiovascular events （MACEs） were assessed 90 d following PCI. Bleeding complications rates were assessed during tirofiban administration. Results ST- segment resolution was achieved in 32 （86.5%） patients in the study group and 25 （67.6%） in the control group （P= O. 053） after PCI. Compared with the control group, peak hs-cTnT level （P= 0.025） and scores of thrombus in the IRA （P=0.O13） were lower, TIMI flow score of 3 （P=0.038） and TMPG 3 （P=0.030） were higher in the study group after PCI. At 90 d after PCI, LVEF in the study group was higher than in the control group （P = 0.026）. Compared with the control group, the 90 d composite MACEs rate tended to decline in the study group （P = 0.053）. The total bleeding rate in the study group was lower than that in the control group （P = 0. 033 ）. Conclusion In aged patients with STEMI undergoing primary PCI, intracoronary bolus plus intravenous low-dose maintenance administration of tirofiban is superior to only intravenous injection for improving coronary flow, myocardial infusion, reducing infarction size and lowering bleeding complications rates.