冠脉内注射替罗非班治疗急性冠脉综合征 介入术后无复流的有效性和安全性

目的 评价冠脉内注射国产盐酸替罗非班对急性冠脉综合征（ACS）介入术后无复流患者TIMI血流的影响及安全性。方法 ACS患者行支架植入术后判定无复流者46例，随机分为替罗非班组(冠脉内注射盐酸替罗非班10 μg/kg)26例，硝酸甘油组(冠脉内注射硝酸甘油200 μg)20例。观察给药后30 min TIMI血流分级及校正的TIMI计帧数（CTFC），2 d后安全性的终点及30 d主要不良心血管事件(MACE)发生率。结果 替罗非班组介入术后无复流患者TIMI Ⅲ级血流获得率显著高于硝酸甘油组(65% vs 30%,P<0.05)；校正的TIMI计帧数显示替罗非班组血流快于硝酸甘油组［(72±19) vs (93±22)，P<0.01］，两组患者30 d的MACE发生率替罗非班组低于硝酸甘油组(4% vs 20%)，但差异未达到显著水平。替罗非班组出血不良反应较硝酸甘油组略高（12% vs 10%），但差别无统计学意义，两组均未见血小板减少。结论 冠脉内注射国产盐酸替罗非班治疗ACS介入术后无复流患者是有效和安全的。

Efficacy and safety of intracoronary tirofiban on no-reflow patients after PCI in acute coronary syndrome

AIM To evaluate the efficacy and safety of intracoronary tirofiban on TIMI flow in acute coronary syndrome (ACS) with no-reflow after PCI. METHODS Forty-six ACS patients with no-reflow after stenting were randomized to tirofiban group (intracoronary tirofiban, 10 μg/kg, n=26) and nitroglyceride group (intracoronary nitroglyceride, 200 μg, n=20). Targets to be observed consisted of corrected TIMI frame count (CTFC), TIMI flow at 30-minute post-medication, safety end-points of 2-day post-PCI and incidence of major adverse cardiovascular events (MACE) of 30-day post-PCI. RESULTS The TIMI 3 ratio in tirofiban group was markedly higher than that in nitroglyceride group (65% vs 30%, P<0.05). CTFC showed that the coronary blood flow in tirofiban group was faster than that in nitroglyceride group (72±19 vs 93±22, P<0.01). No significant difference was found in the incidence of MACE of 30-day post-PCI and bleeding events between tirofiban and nitroglyceride groups (4% vs 20%; 12% vs 10%). No thrombocytopenia was observed in the two groups. CONCLUSION The administration of intracoronary tirofiban is effective and safe for ACS patients with no-reflow after PCI.