冠状动脉内注射替罗非班在急性冠状动脉综合征介入治疗中的安全性和疗效

目的 探讨冠状动脉内注射替罗非班应用于急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗术(PCI)中的安全性及有效性.方法 将58例ACS患者按随机数字表法分为2组:对照组30例,PCI术前6 h内嚼服阿司匹林300 mg和口服氯吡格雷600 mg;替罗非班组28例,在对照组治疗的基础上应用替罗非班10 μg·kg-1原药稀释1倍后通过指引导管于冠状动脉内给药,2 min注射完毕,并以0.1 μg·kg-1·min-1速度维持静脉泵入24 h.2组PCI术后均皮下注射低分子肝素钠4 000 U 5～7 d及其他药物治疗.对2组患者PCI术后的TIMI血流情况、出血事件及术后3个月的不良心脏事件(MACE)进行比较.结果 PCI术后替罗非班组靶血管前向血流TIMI 3级获得率为92.9%,对照组靶血管前向血流TIMI 3级获得率为70.0%,2组比较差异有统计学意义(P＜0.05);替罗非班组出血并发症发生率为14.3%,对照组出血并发症发生率为10.0%,2组比较差异无统计学意义(P＞0.05);替罗非班组术后3个月MACE发生率为3.6%,对照组为13.3%,2组比较差异有统计学意义(P＜0.05).结论 PCI术中冠状动脉内注射替罗非班可以明显改善PCI术后的冠状动脉血流和临床预后,且无明显不良反应.

Efficacy and Safety of Intracoronary Tirofiban Administration in Patients with Acute Coronary Syndromes

Objective To assess the efficacy and safety of intracoronary tirofiban administration in patients with acute coronary syndromes（ACS） treated with percutaneous coronary intervention（PCI）.Methods A total of 58 patients with ACS were randomly divided into two groups.Patients in control group（30 cases） took oral aspirin（300mg） and clopidogrel（600mg） 6 hours before PCI.On this basis,10 μg·kg^-1tirofiban diluted 1-fold was injected into the coronary artery through the guide catheter within 2 minutes and was intravenously infused by the speed of 0.1 μg·kg^-1·min^-1 for 24 hours in tirofiban group.All patients received subcutaneous injection of 4 000 U of low molecular weight heparin for 5~7 days.TIMI grade,bleeding and major adverse cardiac event（MACE） were compared between the two groups.Results The rate of TIMI 3 flow in tirofiban group was markedly higher than that in control group（92.9% vs 70.0%,P0.05）.The incidence of MACE in tirofiban group was obviously lower than that in control group at 3 months after PCI（3.6% vs 13.3%,P0.05）.There were no significant differences in the incidence of hemorrhagic complication between the two groups（14.3% vs 10.0%,P0.05）.Conclusion The intracoronary administration of tirofiban during PCI can effectively improve postoperative coronary flow and clinical outcomes without obvious adverse effects.