加倍负荷剂量替罗非班在急性心肌梗死急诊介入治疗中的应用

目的 观察加倍负荷剂量替罗非班对急性心肌梗死急诊介入治疗的有效性和安全性.方法 选择因急性ST段抬高型心肌梗死入院,并接受急诊直接经皮冠状动脉介入（PCI）治疗的患者98例,分为观察组（加倍负荷剂量替罗非班＋PCI）48例和对照组（常规负荷剂量替罗非班＋PCI）50例.观察两组PCI术前、术后TIMI血流情况、术后心电图ST段回落指数、术后30d射血分数（EF）、30d主要心血管事件（心绞痛、再次心肌梗死和死亡）及出血、血小板减少症、输血等的发生情况.结果 观察组PCI术前梗死相关血管各级TIMI血流与对照组差异无统计学意义（P ＞0.05）.观察组PCI术后即刻达TIMI 3级血流比例（95.8%）高于对照组（78.0%）（P＜0.05）,PCI术后30min达TIMI 3级血流比例（97.9%）高于对照组（86.0%）（P＜0.05）,术后心电图ST段回落指数（75.0%）高于对照组（57.0%）（P＜0.05）.观察组30d心脏EF（44.2%）高于对照组（37.0%）（P＜0.05）,30d内主要心血管事件（心绞痛、再次心肌梗死和死亡）的发生率（4.2%）低于对照组（14.0%）（P＜0.05）.两组出血相关并发症发生率的差异无统计学意义（均P ＞0.05）.结论 加倍负荷剂量替罗非班在急性心肌梗死直接PCI治疗中可改善术后TIMI血流,降低心血管事件,且不增加出血的风险.

Double loading dose tirofiban therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Objective To evaluate the safety and efficacy of double loading dose of tirofiban therapy in patients with acute ST-segment elevation myocardium infarction （STEMI） undergoing primary percutaneous coronary intervention. Methods Ninety-eight STEMI patients undergoing primary PCI were pre-treated with tirofiban. Patients were randomized to receive double loading dose （20 μ g/kg, test group） or routine dose （10 μ g/kg, control group） followed by continuous intravenous injection （0.15 μ g ·kg^-1·min^-1） for 24 h. The TIMI flow grade before and after the operation were reviewed; STRI were measured after PCI; ejection fraction （EF） at d30 after operation was also measured. The primary end points include angina pectoris, re-myocardial infarction and death were compared; the incidences of minor bleeding, major bleeding, thrombocytopenia and transfusion were also compared between two groups. Results There was no difference of TIMI flow between two groups before PCl. A greater percentage of TIMI grade 3 flow was achieved in test group compared with control group after immediate PCl （95.8% vs 78.0%, P〈0. 05） and 30min after PCl （97.9.% vs 86.0%, P〈0.05）. STRI was greater in test group than that in control group after PCl （75.0% vs 57.0%,P〈0.05）. Ejection fraction （EF） at d30 after PCI was higher in test group compared with control group （44.2% vs 37.0%, P〈 0.05）. The frequency of the primary end points at d30 was lower in test group compared with control group （4.2% vs 14.0%, P〈0. 05）. There was no difference of bleeding complication between two groups（P 〉 0.05）. Conclusion Double loading dose tirofiban is safe and effect in patients with STEMI undergoing primary PCI.