替罗非班在急性心肌梗死患者急诊冠状动脉介入治疗无复流中的应用

目的评价冠状动脉内应用血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班,对急性心肌梗死患者梗死相关动脉行直接PCI后无复流现象的效果及对血小板活化功能的影响。方法选择330例急性心肌梗死患者直接行PCI出现无复流者48例,根据其用药情况分为硝酸甘油组(24例)和替罗非班组(24例)。两组均行冠状动脉造影,分别于术前和术后24 h检测血小板GPⅠb、GPⅡb/Ⅲa、GPⅢa。结果与用药前比较,两组术后均能改善冠状动脉血流,硝酸甘油组患者TIMI血流为(1.61±0.38)级vs(1.85±0.42)级(P<0.05),替罗非班组患者TIMI血流为(1.59±0.40)级vs(2.15±0.65)级(P<0.01)。替罗非班组患者术后24 h血小板GPⅠb、GPⅡh/Ⅲa、GPⅢa较术前明显降低(P<0.01)。结论冠状动脉内应用GPⅡb/Ⅲa受体拮抗剂替罗非班较安全。能更有效改善TIMI血流,并能在一定程度上抑制血小板活化。

Application of tirofiban to no-reflow in patients with acute myocardial infarction after PCI

Objective To assess the effect and safety of intra-coronary administration of tirofiban on no-reflow of infarction-related artery following primary PCI and platelet activation in patients with acute myocardial infarction. Methods Forty-eight patients with no-reflow were screened out from 330 AMI patients undergoing direct PCI were enrolled. They were divided into nitroglycerin group(24 patients) and tirofiban group(24 patients). Coronary angiography was performed after the medication. Thrombolysis in myocardial infarction(TIMI) flow grade was measured by two experienced doctors after nitroglycerin or tirofiban administration. Results Compared with before medication,both groups could improve TIMI flow,tirofiban group(TIMI 1.59±0.40 vs 2.15±0.65 grade) was better than nitroglycerin group(TIMI 1.61±0.38 vs 1.85±0.42 grade). Glycoprotein GP Ⅰb,GP Ⅱb/Ⅲa, GPⅢa of platelets were decreased in tirofiban group. Conclusion Intra-coronary administration of GP Ⅱb/Ⅲa receptor antagonist tirofiban can improve the post-PCI no-reflow,and safely and effectively inhibit platelet activation.