急性心肌梗死PCI术前早期应用国产替罗非班对预后的影响

目的 探讨血小板GPⅡb/Ⅲa受体拮抗剂国产替罗非班在急性STEMI患者急诊PCI术前应用的临床疗效.方法 对急救中心收入本科并确诊急性STEMI的120例患者随机分为治疗组和对照组,各60例.两组均接受急诊PCI术,治疗组于入院时即应用替罗非班,对照组未用.主要观察：①PCI手术前后梗死相关动脉TIMI血流;②术后相关导联抬高的ST段回落幅度;③术后4周行超声心动图检查测定左心室射血分数（LVEF）值;④住院期间出血并发症及继发的血小板减少症的发生率;⑤术后3个月的心血管主要不良事件（MACE）发生情况.结果 两组患者临床基本资料无明显差异.替罗非班组术前梗死相关动脉TIMI 0～1级与对照组比较差异有统计学意义（70.0％比90.0％,P＜0.05）,两组PCI术前TIMI 3级比较差异无统计学意义（13.3％比0,P＞0.05）,两组PCI术后TIMI 3级比较有差异有统计学意义（86.7％比63.3％,P＜0.05）.替罗非班组术后2h心电图相关导联ST段完全回落幅度（STR≥70％）高于对照组（P＜0.05）.术后4周超声心动图提示对照组LVEF低于替罗非班组（P＜0.05）.术后替罗非班组轻度出血事件较对照组略有增多,但两组差异无统计学意义（P＞0.05）.两组近期MACE发生率差异无统计学意义（P＞0.05）.结论 急性STEMI患者急诊行PCI术前早期应用国产替罗非班能改善术后心肌再灌注,挽救濒死心肌,恢复存活心肌细胞功能,改善心功能;未明显增加出血事件及主要心血管不良事件,是安全有效的.

Clinical benefits of upstream home-made tirofiban in patients with acute ST-segment elevation myocardial infarction before primary percutaneous coronary intervention

Objective To observe the clinical benefits of home-made tirofiban （platelet glycoprotein Ⅱb/Ⅲa receptor antagonist） in patients with acute STEMI before primary PCI. Methods 120 patients with acute STEMI diagnosed by emergency centre were being treated by primary PCI, and randomly divided into tirofiban group （n=60） and control group（n=60）. The TIMI grade flow of infarct-related artery （IRA） before and after PCI was assessed. The resolution of the sum of ST-segment elevation at 2 hours after PCI was ob- served. The left ventricular ejection fraction （LVEF）was measured by ultrasonic cardiogram 4 week after PCI. The incidences of the bleeding complications and thrombocytopenia during hospitalization and The major ad- verse cardiac events rates 3 month after PCI was record. Results TIMI grade 0-1 flow of IRA in control group at initial angiography before PCI was significantly higher than that in tirofiban group（90.0% vs 70.0%, P〈0.05）. There were no difference in TIMI grade 3 flow before PCI between two groups （0 vs 13.3%, P〉 0.05）.TIMI grade 3 flow in tirofiban group was higher than that in control group after PCI （86.7% vs63.3% ,P〈0.05）. There were no difference in TIMI grade 0-1 flow after PCI between two groups （0 vs 10.0% ,P〉0.05）. There was more frequently complete STR in tirofiban group than that in control group （63.3% vs 36.7%, P〈0.05）. LVEF in control group was lower than that in tirofiban group（P〈0.05）. Hemor- rhage rate in tirofiban group was higher, but there was no difference between two groups（P〉0.05）. The inci- dence of MACE in control group was higher than that in tirofiban group,but there was no difference （P〉 0.05）. Conclusion Administration of home-made tirofiban before primary PCI on patients with acute STE- MI can make better the myocardial reperfusion, retrieve the moribund myocardium, recover survival function and improve the heart function. It does not increase the hemorrhage rate and the incidence of MACE, and it is safe and effective.