替罗非班联合IABP对冠脉复杂病变患者PCI术后的近期疗效观察

目的 探讨替罗非班联合主动脉球囊反搏(IABP)对冠脉复杂病变患者行经皮冠状动脉介入治疗(PCI)疗效及预后的影响.方法 回顾性分析2011年1月至2013年12月冠心病有胸痛症状经冠脉造影提示复杂病变并行PCI患者90例,按照PCI术后是否使用替罗非班以及是否应用IABP分为替罗非班组(A组)、替罗非班联合IABP组(B组)和IABP组(C组),每组30例.比较3组临床资料、 血管病变情况、术后心功能指标、出血并发症和血小板减少症的发生率,术后30 d内心血管病事件的发生率等.结果 术后5 d:左室射血分数B组和C组高于A组(P<0.05),BNP值A组明显高于B组和C组(P<0.05).3组间血小板计数差异无统计学意义(P >0.05),B组有1例、C组有2例发生血小板减少,停用肝素及撤离IABP 3 d后,血小板计数恢复正常.总主要心血管事件(MACE)发生率B组显著低于A组和C组(P<0.05).结论 冠脉复杂病变患者于PCI术中早期联合应用替罗非班及主动脉内球囊反搏,有降低PCI术后30 d内MACE事件发生率的趋势,显著改善冠脉血流和心肌灌注并不增加出血风险.

Short-term efficacy of tirofiban combined with IABP for patients with complex coronary artery disease after PCI

Objective To explore the efficacy and prognosis of tirofiban combined with intra aortic balloon pump (IABP) for patients who had complex coronary artery disease after undergoing percutaneous coronary intervention (PCI). Methods Data of 90 cases of complex coronary artery disease confirmed by coronary angiography who underwent PCI during Jan. 2011 to Dec. 2013 in our hospital were retrospectively analyzed. Patients were divided into three groups: tirofiban group (Group A), tirofiban combined with IABP group (Group B), and IABP group (Group C). The vascular lesions, postoperative cardiac function index, bleeding complications and incidence of thrombocytopenia, and incidence of heart disease 30 days after PCI were compared. Results Five days after PCI, left ventricular ejection time (LVEF) in groups B and C were higher than than that in group A (P<0.05), and the level of BNP was significantly higher in Group A than in groups B and C (P<0.05). Platelet counts showed no significant differences among the three groups (P >0.05). One patient in group B and 2 in group C developed thrombocytopenia, but 3 days after stopping using heparin and withdrawing IABP, the platelet count returned to normal. The incidence of major adverse cardiovascular events (MACE) was significantly lower in group B than in groups A and C. Conclusion During PCI, combining tirofiban and IABP early for patients who had complex lesions can significantly improve coronary blood flowand myocardial perfusion, and reduce the incidence of MACE within 30d without increasing the risk of bleeding.