替罗非班在老年急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗中的临床观察

目的：评价血小板膜糖蛋白（GP）Ⅱb/Ⅲa受体拮抗剂替罗非班在老年ST段抬高急性心肌梗死（STEMI）急诊冠状动脉介入治疗（PCI）中的疗效和安全性。方法：入选2007年3月～2009年3月56例老年STEMI行急诊PCI的患者按入院时间先后分为两组,治疗组（替罗非班＋PCI）30例、对照组（直接PCI）26例。分析两组的临床情况和冠脉造影资料,观察PCI术前、后TIMI血流分级,术后90分钟心电图ST段抬高回落,随访30天内主要心血管不良事件和出血发生率。结果：治疗组TIMI血流2级和3级血流发生比率升高,两者比较差异显著（P〈0.05）。PCI术后治疗组心电图ST段回落幅度高于对照组,两组比较差异显著（P〈0.05）。30天内不良心血管事件比较,治疗组低于对照组,两组比较差异显著（P〈0.05）。发生出血并发症两组比较无统计学意义（P〉0.05）。结论：老年急性ST段抬高心肌梗死患者PCI术应用替罗非班是安全、有效的。

Application of Tirofiban in Emergent Percutaneous Coronary Interventional Therapy in Elder Patients with ST-Elevation Myocardial Infarction

OBJECTIVE：To evaluate the efficacy and safety of tirofiban,a platelet membrane glucoprotein（GP） Ⅱb/Ⅲa receptor antagonist,used in percutaneous coronary interventional therapy（PCI） for elder patients with acute ST-elevation myocardial infarction（STEMI）.METHODS：Fifty-six aged patients with acute STEMI admitted to our hospital between March 2007 and March 2009 were divided into two groups based on the time of admission：30 patients in treatment group assigned to receive tirofiban plus PCI and 26 patients in control group to receive PCI directly.The clinical and coronary angiography data,TIMI blood flow grade before and after PCI,the fall of ST-segment elevation at 90 minutes after operation,the main adverse cardiac events（MACE） within 30 days after PCI and the incidence of hemorrhage were analyzed.RESULTS：TIMI-2 flow and TIMI-3 flow had higher incidence in the treatment group than in the control group,and the the differences were significant（P 0.05）.The ST-segment elevation after PCI had greater reduction in the treatment group than in the control group and the differences were significantly significant（P 0.05）.The degree of the fall of ST-segment elevation was higher in the treatment group than in the control group,and the differences were significant（P 0.05）.MACE incidence within 30 days was lower in the treatment group than in the control group,showing significant differences between the two groups（P 0.05）.There was no significant difference between the two groups in terms of bleeding complication（P 0.05）.CONCLUSION：Tirofiban is safe and effective for elderly patients with acute STEMI undergoing PCI.