早期维持量联合冠脉内团注负荷量替罗非班对老年急性心肌梗死患者介入术后的影响

目的 观察老年STEMI患者早期维持量联合冠脉内团注负荷量替罗非班的可行性,初步观察该治疗方案对PCI术后的安全性和有效性.方法 80例接受急诊PCI的老年STEMI患者,随机分为2组.试验组诊断明确后立即静脉给予替罗非班维持量0.15 μg;kg-1;min-1泵入,IRA恢复前向血流时,于冠脉内团注负荷量替罗非班10μg/kg;对照组静脉给予替罗非班负荷剂量10 μg/kg,继以0.15 μg· kg-1·min-1维持泵入.两组患者术后均持续泵入48 h.观察血小板聚集率变化情况,比较PCI术前、术后罪犯病变TIMI血流情况,PCI术后心肌灌注TMPG分级,ST段回落情况,围手术期出血情况,术后心功能情况及主要心脏不良事件发生率.结果 两组患者基线资料差异均无统计学意义；两组间血小板聚集率、术前术后TIMI血流分级差异无统计学意义；术后心肌灌注TMPG分级及ST段回落情况两组间差异有统计学意义；术后7d和9个月MACE及围手术期出血情况两组间差异无统计学意义.试验组术后9个月超声心动图及无MACE生存率均优于对照组,且差异有统计学意义.结论 早期维持量联合冠脉内负荷量团注替罗非班对老年STEMI患者可以改善其临床预后,并不增加出血风险.

Early maintenance dose administration as well as bolus intracoronary tirofiban of loading dose in elderly patients with ST-elevation myocardial infarction after percutaneous coronary intervention

Objective The aim of this study was to observe the efficacy and safety of early mainte- nance dose administration as well as bolus intracoronary tirofiban of loading dose in elderly patients with ST- elevation myocardial infarction after percutaneous coronary intervention. Methods 80 elderly patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention were divided into two groups randomly. 40 were allocated to experimental group, who were given tirofiban intravenous with a maintenance dose of 0.15μg·kg-1·min-1 immediately since definite diagnosis in emergency room,and fol- lowed with intracoronary administering of a load dose of 10 μg/kg through the guiding catheter after first restoration of antegrade flow in infarct related artery. 40 were allocated to control group, who were given tirofiban with a load dose of 10 μg/kg injected immediately since definite diagnosis,followed by infusion at 0.15μg·kg-1·min-1. All patients received a continuous intravenous dripping of tirofiban for 48 hours.Platelet aggregation, preoperative TIMI, postoperative TIMI, TIMI myocardial perfusion grades （TMPG）, ST-segmentresolution,bleeding complications during hospitalization were examined. The Patients were followed for 9 months for any major adverse cardiac events （MACE）. Results Baseline characteristics of the two groups were well-balanced.Platelet aggregation and TIMI flow rate in both groups were no significant differences.The TIMI myocardial perfusion grades （TMPG） and ST-segment resolution rate were significantly higher in experi- mental group than in control group. At 7 days and 9 months follow-up, the MACE rate was not significantly different.Bleeding events were similar between the two groups.Left ventricular ejection fraction and MACE-free survival was improved in experimental group. Conclusion Early maintenance dose administration combined with intracoronar;y tirofiban of loading dose in elderly patients with ST-elevation myocardial infarction undergo- ing percutaneous coronary intervention may be resulted in a better chnical prognosis,and no severe bleeding oecudined.