国产替罗非班对急诊冠脉介入治疗患者的远期预后作用

目的：探讨急诊经皮冠状动脉介入治疗（PCI）中使用国产替罗非班（欣维宁）对患者的远期无事件生存率及心功能的影响。方法：回顾性分析我院2003年3月至2006年3月急诊PCI治疗患者117例，按是否使用国产替罗非班分为治疗组（n=36）和对照组（n-81），随访1年，观察并比较两组的全因死亡率、心肌梗塞率、靶血管重建率及左室射血分数（LVEF）、左室舒张末期容积指数（LVEDVI）、左室收缩末期容积指数（LVESVI）。结果：两组一般情况、基础临床情况和造影、介入资料均无显著差异（P〉0．05），且两组术后即刻TIMIⅢ级血流相似（94．44％：92．59％P〉0．05）。术后随访1月时，两组均无主要心血管事件发生。两组LVEF均较术前有明显改善，但治疗组改善更明显（47．89％：41．75％P〈0．05）；且治疗组LVEDVI（73．49ml／m^2）和LVESVI（42．86ml／m^2）均较对照组（82．77ml／m^2、53．52ml／m^2）明显下降（P均〈0．05）。随访1年，治疗组有3例发生主要心血管事件，对照组有6例，无事件生存率两组间无显著差异（8．33％：7．41％P〉0．05）。两组心功能较术后1月有明显改善，但两组心功能相比未见显著差异。结论：急诊PCI术中使用国产替罗非班对远期无事件生存率无影响，但能明显改善患者PCI术后1月的心功能，而1年后这种获益不复存在。

Prognosis effect of tirofiban made in China in patients with primary percutaneous coronary intervention

Objective; To investigate the effect of tirofiban made in China on event-free survival and cardiac function recovery in patients with primary percutaneous coronary intervention （PCI）. Methods： A total of 117 patients who underwent primary PCI between March 2003 to March 2006 were divided into two groups： the tirofiban treatment group （n= 36） and the control group （n= 81）. The occurrence of the composite endpoint of death, myocardial infarction or target vessel revascularization and left ventricular ejaculation fraction （LVEF）, left ventricular end-diastolic volume index （LVEDVI）, left ventricular end-systolic volume index （LVESVI） were assessed at 1 year after PCI. Results： There was no significant difference between two groups in basic clinical or angiographic characteristics before PCI （P 〉0.05）. The two groups had no difference in percentage of TIMI Ⅲ flow achieved in infarction relate artery （IRAs） after PCI （94.44% ： 92.59% P〉0. 05）. No MACE in both groups after 1 month follow-up. Furthermore heart function in two groups had improved. But higher LVEF （47.89% ： 41.75% P〈0.05） and fewer LVEDVI （73. 49ml/m^2 ： 82.77 ml/m^2 P〈0.05）, LVSDVI （42.86 ml/m^2： 53.52 ml/m^2 P〈0.05） were achieved in the tirofiban treatment group. At 1 year after PCI, there was no significant difference between two groups in occurrence of MACE （8.33%： 7.41% P〉0.05） and cardiac function improvement. But heart function was dramatically improvement compared with 1-month after PCI. Conclusion： Application of tirofiban made in China during primary PCI in patients with acute myocardial infarction improved heart function at 1 month after PCI, but this benefit did not continue to 1 year. Nevertheless, the rate of event-free survival was no significant difference between two groups during 1-year follow-up.