急性ST段抬高型心肌梗死患者围PCI手术期应用替罗非班的临床疗效评价

目的 探讨急性ST段抬高型心肌梗死（ST segment elevation myocardial infarction,STEMI）患者行急诊经皮冠状动脉介入治疗（percuteous coronary intervention,PCI）时,围术期应用替罗非班对术后冠脉血流、心肌灌注及近期疗效的影响.方法 共入选150例行急诊PCI治疗的急性STEMI患者,将其随机分为围术期应用替罗非班加肝素组（实验组）（75例）和肝素组（对照组）（75例）两组.分析两组患者术前基础临床情况、术后冠TIMI血流分级、心肌灌注、左心室射血分数、术后3个月主要心血管事件（major adverse cardiac events,MACE）.结果 两组患者基础临床情况差异无统计学意义,实验组患者术后梗死相关动脉前向血流达到TIMI3级的比例高于对照组（92.0%和77.3%,P＜0.05）.随访3个月时,实验组MACE的发生率低于对照组.临床出血并发症发生率差异无统计学意义（P＞0.05）.结论 替罗非班加肝素组有效减少AMI急诊PCI治疗术中无复流的发生及明显改善靶血管前向血流TIMI分级,减少患者术后MACE的发生率,安全性好,不增加出血发生率,临床应用安全有效.

Application and safety analysis of tirofiban on PCI perioperative period acute myocardial infarction

Objective To investigate the influences of tirofiban （blocker of intracoronary platelet gluco-protien receptor IIb/IIIa） on coronary perfusion and clinical prognosis in the patients with acute ST-elevation myocardial infarction （STEMI） during percuteous coronary intervention （PCI）. Methods The 150 patients with acute STEMI undergoing emergencey PCI were chosen and randomly divided into the group of heparin and tirofiban （ experimental group, n = 75 ） and the group of heparin （ control group, n = 75 ）. The T/MI flow grate before and after the operation were reviewed. STR1 were measured after PCI. The elinieal ,left ventrieular ejection fraction and angiographie features （coronary arteries blood flow TIMI grade 、TIMI myocardial perfusion TMP and） between two groups before and after PC1 were analyzed. The incidence rate of major adverse cardiac events （MACE） during follow-up period were compared between two groups after PCI. Results There were no dife- fence in baseline characteristics between the two groups before PCI. After treatment with stenting, final TIMI flow grade 3 was observed more frequently in test group compared with control group （92.0% vs77.3% ,P 〈 0. 05 ）. while the combine incidence of MACE during 30 Days follow-up was significantly lower in the test group compared with control group. The serious bleeding complications were similar between two groups （ P 〉 0. 05 ）. Conclusion Application of tirofiban could significantly improve forward blood flow in target vessels and reduce the incidence of MACE in patients with AMI PCI. It is ability to prevent no-reflow phenomenon, It is effective and safe in AMI patients treated with primary PCI.