不同剂量替罗非班在急诊PCI中的临床疗效评价

目的：评价不同剂量替罗非班在急诊急性ST段抬高型心肌梗死患者行经皮冠状动脉介入术（PCI）中的临床疗效及安全性。方法：将247例急性ST段抬高型心肌梗死（STEMI）患者随机分为对照组（替格瑞洛联合阿司匹林等）、半量组（在对照组基础上,术中至术后24~48 h使用微量泵按0.05 μg·kg^-1·min^-1持续静脉泵入替罗非班）、全量组（在对照组基础上,术中至术后24~48 h内使用微量泵按0.1 μg·kg^-1·min^-1持续静脉泵入替罗非班）,比较3组患者在用药前后24 h血小板聚集率变化,以及PCI术后即刻冠脉血流TIMI分级、校正TIMI计帧、ST段抬高恢复情况、血清炎症因子、主要不良心脏事件、不良反应发生情况及出血并发症等。结果：与对照组相比,半量组患者PCI术后即刻冠脉TIMI血流分级明显偏高（P<0.05）,全量组稍高与对照组,但差异没有显著性（P>0.05）;半量组和全量组患者CTFC帧数明显偏低（P<0.05）;TMP2级以上患者比例明显高于对照组（P<0.05）。与治疗前相比,各治疗组患者血清MPA、cTnI、CK-MB含量均明显降低（P<0.05）;半量组和全量组患者上述血清指标降低程度更为明显,组间比较差异具有显著性（P<0.05）。各剂量组患者在经PCI术后90 min ST段抬高情况均有不同程度的回落。其中半量组和全量组在完全回落率明显高于对照组,未回落率显著低于对照组,组间比较差异具有显著性（P<0.05）。全量组和半量组在ST段回落情况差异不显著,组间比较差异没有显著性（P>0.05）。半量组和全量组患者血清CRP、IL-6、TNF-α表达水平在各观察点差异均没有显著性（P>0.05）。与对照组相比,半量组和全量组不良反应发生率均明显偏低,组间比较差异具有显著性（P<0.05）;半量组与全量组不良反应发生率差异没有显著性（P>0.05）。与对照组相比,半量组和全量组不良心血管时间发生率明显偏低（P<0.05）,半量组与全量组之间差异无显著性（P>0.05）。结论：半剂量的替罗非班联合替格瑞洛可更好地发挥抗血小板聚集,抑制血栓形成,改善冠脉血流及心肌损伤,降低MPA,减少"无再流"现象的发生,不增加出血风险。

Evaluation of clinical efficacy of tirofiban at different doses in emergency PCI

OBJECTIVE To evaluate the safety and efficacy of tirofiban in the treatment of acute coronary syndrome.METHODS Totally 247 STEMI patients were randomly divided into control group (ticagrelor combined with aspirin),half dose group (based on the control group,0.05 μg·kg^-1·min^-1 tirofiban was transfused),full dose group (based on the control group,0.1 μg·kg^-1·min^-1 tirofiban was transfused).The 3 groups of patients were compared for 24 h platelet aggregation rate changes,the coronary blood flow TIMI grade immediately after PCI,corrected TIMI frame count,ST elevation recovery,serum inflammatory factors,major adverse cardiac events,the incidence of adverse reactions and complications such as bleeding.RESULTS Compared with the control group,half dose group had significantly higher coronary blood flow TIMI grade immediately after PCI (P<0.05),full dose group was also higher (P>0.05),half and full dose groups had significantly lower CTFC frames (P<0.05),and obviously more patients with higher TMP2 levels (P<0.05).After treatment,serum MPA,cTnI and CK-MB were obviously decreased (P<0.05),particularly more obvious in half and full dose groups than in control group (P<0.05).The patients in all groups had reduced ST elevation 90min after operation,particularly more obvious in half and full dose groups than in control group (P<0.05),but no significant difference was observed between half and full dose groups (P>0.05).The serum levels of CRP,IL-6 and TNF-alpha were not significantly different between the half and full dose groups (P>0.05).Compared with the control group,half and full dose groups had significantly less adverse reactions (P<0.05),but no significant difference was observed between half and full dose groups (P>0.05).Compared with the control group,half and full dose groups had significantly less adverse cardiovascular events (P<0.05),but no significant difference was observed between half and full dose groups (P>0.05).CONCLUSION Half dose tirofiban combined with ticagrelor is superior in antiplatelet aggregation,inhibition of thrombosis,improvement of coronary flow and myocardial injury,reduction of MPA and "no reflow" phenomenon,and will not increase the risk of hemorrhage.