盐酸替罗非班对心肌梗死患者微循环再灌注的影响

目的探讨血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班对急性心肌梗死(AMI)患者直接经皮冠状动脉内介入治疗(PCI)术后心肌微循环灌注的影响。方法将急诊入院的AMI患者79例,随机分为盐酸替罗非班组(39例)和一般治疗组(40例)。比较两组患者直接PCI后心电图ST段下降程度、QT离散度(QTd)。结果两组患者在年龄,性别,危险因素,心肌梗死部位,病变血管数以及就诊和介入治疗时间等方面均无明显差异。PCI术后30 min,盐酸替罗非班组ST段下降≥50%的患者明显高于一般治疗组(92.3%vs70.0%P=0.020)。PCI术后2 h盐酸替罗非班组ST段下降≥70%的患者,明显高于一般治疗组(82.1%vs60.0%P=0.031);且盐酸替罗非班组的酶峰时间较一般治疗组提前3.2 h,P=0.003。PCI术后30 min和2 h心电图QTd明显低于一般治疗组(P<0.05)。盐酸替罗非班组住院期间心力衰竭的发生率较一般治疗组明显减少(2.6%vs22.5%,P=0.014);严重出血事件与一般治疗组比较无差别。结论直接PCI术前应用盐酸替罗非班有助于AMI患者冠脉微循环再灌注,改善心功能,降低心力衰竭的发生率。

Effect of tirofiban hydrochloride on myocardial microcirculation in patients after acute myocardial infarction

Objective To explore the effect of tirofiban hydrochloride,the inhibitor of platelet GP Ⅱb/Ⅲa receptar,on myocardial microcirculation in patients with acute myocardial infarction(AMI) after direct percutaneous coronary intervention(PCI).Methods Seventy-nine AMI patients were divided into tirofiban group(n=39) and traditional treatment(TT) group(n=40) at random.Two levels of ST segment depression(50% and 70%) and QT dispersion(QTd) were compared between the 2 groups at 30 min and 2 h after direct PCI.Results ST segment depression over 50% at 30 minutes after PCI was observed in 92.3% of tirofiban group and 70.0% of TT group,P=0.020.Two hours after PCI,the rate of ST segment depression over 70% was higher in tirofiban group than in TT group(82.1% vs 60.0%,P=0.031).Time to peak creatine kinase and troponin I was 3.2 h shorter in tirofiban group than in TT group,P=0.003.QTd was significantly shorter in tirofiban group than in group both at 30 min and 2 h after PCI,P<0.05.Heart failure was observed in 22.5% of TT group,which was much higher than 2.6% in tirofiban group,P=0.014.There was no difference in major bleeding events between the two groups.Conclusion Early administration of GP Ⅱb/Ⅲa inhibitor before direct PCI can improve myocardium microcir-culation in patients with AMI.