半量替罗非班在老年急性心肌梗死急诊经皮冠状动脉介入治疗的疗效和安全性

目的探讨半量替罗非班对老年急性ST段抬高心肌梗死(STEMI)患者急诊PCI的疗效及安全性。方法入选STEMI行急诊PCI老年患者114例,随机分为标准剂量组56例和半量组58例。标准剂量组给予替罗非班0.10⁰.15μg/(kg·min)静脉滴注48h,半量组给予0.050.15μg/(kg·min)静脉滴注48h,半量组给予0.05⁰.075μg/(kg·min)静脉滴注24h。比较2组TIMI及心肌染色分级(MBG)20.075μg/(kg·min)静脉滴注24h。比较2组TIMI及心肌染色分级(MBG)2³级血流率,术后90min的ST段回落百分比(sumSTR)、LVEF、左心室舒张末和收缩末内径变化及主要心脏不良事件、出血、消化道不良反应的发生率。结果标准剂量组TIMI及MBG 23级血流率,术后90min的ST段回落百分比(sumSTR)、LVEF、左心室舒张末和收缩末内径变化及主要心脏不良事件、出血、消化道不良反应的发生率。结果标准剂量组TIMI及MBG 2³级血流率较半量组虽有升高趋势,但差异无统计学意义(P>0.05);2组术后90min的sumSTR>50%比例及患者住院期间不良事件发生率比较,差异无统计学意义(P>0.05);半量组出血发生率低于标准剂量组(3.45%vs 16.07%,P<0.05)。结论半量替罗非班在预防缺血方面的疗效与标准剂量相当,但在出血风险方面的安全性明显升高。

Efficacy and safety of half tirofiban dose in elderly patients with ST-segment elevation acute myocardial infarction after PCI

Objective To study the efficacy and safety of half tirofiban dose in elderly patients with STEMI after PCI.Methods One hundred and fourteen STEMI patients after PCI were randomly divided into standard tirofiban dose group(n=56)and half tirofiban dose group(n=58).Patients in standard tirofiban dose group were intravenously injected with tirofiban at the dose of 10μg/kg within 3min followed by intravenous infusion at athe dose of 0.10-0.15μg/(kg·min)for 48h and those in half tirofiban dose group were intravenously injected with tirofiban at the dose of 5 μg/kg within 3min followed by intravenous infusion at the dose of 0.05-0.075μg/(kg·min) for 24h.The following parameters were compared between the two groups,inclusing thrombolysis in myocardial infarction(TIMI),MBG 2-3blood flow,resolution of the sum of ST-segment elevation(sum-STR)90min after operation,and LVEF,LVEDD,LVESD,and incidence of major adverse cardiovascualr events,bleeding and gastrointestinal symptoms after operation.Results No significant difference was found in the TIMI,MBG 2-3blood flow,sum-STR>50%,and incidence of adverse events 90min after operation between the two groups,although they were higher in standard tirofiban dose group than in half tirofiban dose group(P>0.05).The incidence of bleeding was significantly lower in half tirofiban dose group than in standard tirofiban dose group(3.45%vs 16.07%,P<0.05).Concluslon The efficacy of standard tirofiban dose and half tirofiban dose is similar in prevention of ischemia.However,the safety of half tirofiban dose is better than that of standard tirofiban dose in prevention of bleeding risk.