替罗非班对急性冠脉综合征经皮冠状动脉介入术后无复流现象的影响

目的观察盐酸替罗非班对急性冠脉综合征（ACS）患者经皮冠状动脉介入术（PCI）后无复流现象的影响。方法纳入ACS患者行PCI治疗术后无复流患者72例,随机分为替罗非班组36例和对照组36例。对照组经冠状动脉给予硝普钠0.9μg/kg,替罗非班组经冠状动脉给予盐酸替罗非班负荷剂量10μg/kg,3min内注完,随后以0.15μg/（kg·min）微量泵持续静脉泵入24h。观察两组患者冠脉给药前、给药后20min靶血管前向血流的TIMI血流分级、心电图改变及术后2周内主要不良心脏事件及药物的不良反应。结果冠状动脉内给药20min后造影显示,两组患者梗死相关动脉TIMI血流分级均较给药前有改善,替罗非班组IRA的TIMI血流0级、1级发生率显著低于对照组,TIMI血流3级发生率显著高于对照组,差异均有统计学意义（P〈0.01）;冠状动脉给药2h后与给药前比较,对照组心电图改善不明显,而替罗非班组患者心电图获得显著改善,两组冠脉给药2h后ST抬高及压低程度、缺血损伤导联数差异均有显著统计学意义（P〈0.01）;术后2周内替罗非班组主要不良心脏事件显著低于对照组（P〈0.01）;术后2周内两组不良反应的发生率差异无统计学意义（P〉0.05）。结论经冠状动脉给予盐酸替罗非班治疗可有效地改善ACS患者术后无复流现象,并减少术后2周内主要不良心脏事件。

Influence of tirofiban on no-reflow after percutaneous coronary intervention in patients with acute coronary syndrome

Objective To observe the influence of tirofiban on no-reflow after percutaneous coronary intervention(PCI) in patients with acute coronary syndrome(ACS).Methods There were 72 ACS patients with no-reflow after PCI selected and then they were randomly divided into tirofiban group(n=36) and control group(n=36).Control group was injected sodium nitroprusside(0.9 μg/kg) through coronary artery and treatment group was injected tirofiban in loading dose(10 μg/kg) through coronary artery within 3 minutes,and then pumped into vein in dose of 0.15 μg/(kg·min) by using micro-pump for 24 hours.The changes of thrombolysis in myocardial infarction(TIMI) grade and ECG of target vessel forward flow before and 20 minute after drug administration,and major adverse cardiac events and drug adverse reactions within 2 weeks after PCI were observed in two groups.Results The results of angiography 20 minutes after drug administration showed that TIMI grade of infarction-related arteries was improved in two groups than before drug administration.In tirofiban group the occurrence rates of 0 and 1 TIMI grades were significantly lower than those in control group but the occurrence rate of 3 TIMI grade was significantly higher than that in control group(P<0.01).The changes of ECG was not significant in control group before and 2 hours after drug administration,while in tirofiban group ECG had significant improvement.The differences in degree of ST-elevation and ST-depression and leads of ischemia injury had statistical significance(P<0.01) in two groups 2 hours after drug administration.Within 2 weeks after PCI,the major adverse cardiac events were less in tirofiban group than those in control group(P<0.01),and the difference in occurrence rate of drug adverse reactions had no statistical significance(P>0.05) between two groups.Conclusion The treatment with tirofiban through coronary artery can effectively relieve no-reflow after PCI and reduce major adverse cardiac events within 2 weeks after PCI in ACS patients.