高危ACS患者PCI术前早期和即刻应用替罗非班对冠脉血流和心肌灌注的影响

目的：探讨经皮冠状动脉介入治疗（PCI）术前早期或即刻应用替罗非班对高危急性冠脉综合征（ACS）患者冠脉血流和心肌灌注的影响。方法：78例高危ACS患者随机分为早期组（PCI术前4-6h给予替罗非班，n=39）与即刻组（PCI术中导丝通过病变时立即给予替罗非班，n=39），对比两组患者血清心肌肌钙蛋白Ⅰ（cTnI）、心肌激酶同工酶（CK—MB）、血小板聚集率（PAR）、心电图ST段改变、TIMI血流分级、TIMI心肌灌注分级、主要心脏不良事件（MACE）以及不良反应发生率。结果：与给药前相比，两组患者给药后cTnI、CK—MB均明显增高（P〈0．01），PAR显著降低（P〈0．01），但给药后两组患者此3项指标差异均无统计学意义（P〉0．05）；术后两组患者TIMI血流分级以及TMPG分级均显著改善（P〈0．01），且术后早期组患者TMPG分级显著优于即刻组（P〈0．05）；给药后两组患者ST段压低程度显著减轻（P〈0．01），缺血导联数目显著减少（P〈0．01），且给药后早期组患者ST段压低程度显著低于即刻组（P〈0．01）；两组患者术后MACE发生率及不良反应发生率比较均无统计学差异（P〉0．05）。结论：替罗非班应用于高危ACS患者PCI围手术期能够有效增加心肌灌注，改善患者心肌缺血状态，早期应用效果更佳。

Effects of early application and immediate application of tirofiban on coronary blood flow and myocardial perfusion in patients with high-risk acute coronary syndrome undergoing percuta- neous coronary intervention

Objective： To explore the clinical effects of early application and immediate application of tirofiban on coronary blood flow and myocardial perfusion in high-risk ACS patients undergoing PCI. Methods： A total of 78 patients with highrisk ACS undergoing PCI were randomly divided into the early group （n= 39） and the immediate group （n= 89）. Tirofiban were given 4 6 h before PCI in the early group, and tirofiban were given immediately after PCI guidewire surgery through the lesion given, cTnI, CK MB, PAR, ST segment changes, TIMI, TMPG, MACE, and adverse reactions rates were contrasted between two groups. Results： cTnI and CK-MB were significantly higher after administration （P〈0.01） ; PAR was significantly lower after administration in the two groups （P〈0.01）, and the difference was significant between the two groups （P〉 0.05） ; TIMI and TMPG were significantly improved in the two groups after administration（P〈0.01）, and TMPG in the early group were significantly better than the immediate group （P〈0.05）; ST segment depression and number of ischemic ECG were significantly reduced after administration in the two groups （P〈0.01）, and ST segment depression in the early group was significantly lower than the immediate group（P〈0.01） ; there was no significantly difference in MACE and adverse reactions rates between the two groups after PCI（P〉0.05）. Conclusion： Tirofiban perioperative can effectively increase myocardial perfusion and improve myocardial ischemia in patients with high-risk ACS undergoing PCI, and early application is much better.