盐酸替罗非班在老年急性冠状动脉综合征患者中的应用

目的 评价老年急性冠状动脉综合征(ACS)患者应用替罗非班的有效性和安全性.方法 选择2006年12月至2008年6月在苏北人民医院住院的老年ACS患者106例进行前瞻性随机对照研究,根据是否行PCI分为PCI组和药物保守治疗组,两组患者再随机分为替罗非班治疗业组和常规治疗亚组,PCI组术前给予负荷量替罗非班10 μg·kg-1,3 min内静脉注射完毕,继而以0.15 μg·kg-1·min-1持续泵入24～36 h.药物保守治疗组(负荷量0.4 μg·kg-1·min-1× 30 min,维持量0.1 μg·kg-1·min-1×48 h).采用成组t检验和方差分析法(ANOVA)分析比较各亚组间住院期间及随访30 d主要心血管事件(死亡、新的心肌梗死和顽固性心肌缺血)的发生率、出血的发生率及PCI治疗组术后TIMI分级、校正的TIMI计帧数(CTFC)及心肌Blush分级(MBG).结果 各亚组间一般资料相似,药物保守治疗组中替罗非班亚组随访30 d MACE发生率较常规治疗亚组显著降低(12.0%vs.36.4%;P<0.05),PCI治疗组中替罗非班亚组CTFC低于常规治疗亚组(23.5±5.1)帧和(31.4±5.2)帧,P<0.01],Blush 3级获得率明显高于常规治疗亚组(64.3%和29.0%,P<0.01).出血发生率两组无统计学意义(P>0.05).结论 老年ACS患者使用替罗非班具有更好的血流及心肌灌注,减少缺血事件发生,且安全性好.

Safety and efficacy of tirofiban in elderly patients with acute coronary syndrome

Objective To evaluate the safety and efficacy of firofiban in gerontal patients with acute coronary syndrome(ACS). Method A total of 106 elderly patients with ACS admitted form December 2006 to June 2008 were enrolled in a prospective case-control study. Patients were divided into percutaneous coronary intervention (PCI) group and medicine group. Both groups were randomly divided into two sub-groups, tirofiban sub-group and placebo sub-group. Patients in the PCI group received tirofiban infused in dose of 10 μg·kg- within 3 minutes as loading dose before operation and then an infusion of 0.15μg'kg-1·min-1 as maintenance dose for 24～36 hours. In medicine group,the loading dose was 0.4 μg·kg-1·min-1×30 min and the maintaining dose was 0.1 μg·kg-1·min-1×48 hours, The rates of major adverse cardiac events (MACE) consisting of death, myocardial infarction or refractory ischemia during hospital stay stay and 30 days' follow-up, bleeding rates TIMI grade, corrected TIMI frame count (CTFC) and myocardial blush grade(MBG) after PCI were compared between sub-groups of PCI group. Results The basic clinical data were similar among the sub-groups. In medicine group,the MACE rate during 30 days' follow-up was much lower in the tirofiban sub-group than in the placebo sub-group (12.0% vs. 36.4 %, P < 0.05). In comparison with medicine group, in PCI group, there were fewer TIMI frames (23.5 ±5.1) frames vs. (31.4±5.2) frames, P < 0.01] and higher percentage of myocardial blush grade 3(64.3% vs. 29.0%, P < 0.01) in firotiban sub-group of PCI group. No significant differences in bleeding rates were found between all sub-groups. Conclusions Tirofiban is safe and effective in gerontal ACS patients with blood flow and reperfusion improved.