早期应用替罗非班对急性ST段抬高型心肌梗死急诊行经皮冠状动脉介入术后心肌组织灌注的影响被引量：3

Effect of tirofiban on myocardial perfusion after primary percutaneous intervention in patients with acute ST-segment elevated myocardial infarction at early stage

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摘要目的评价国产早期应用血小板膜糖蛋白GPⅡb/Ⅲa受体拮抗剂替罗非班对急性ST段抬高型心肌梗死(STEMI)急诊行经皮冠状动脉介入术(PCI)后心肌组织灌注及安全性的影响。方法回顾分析2007-05～2010-11期间因初次急性STEMI入住运城市中心医院CCU行急诊经桡动脉PCI治疗的患者108例,其中联合替罗非班治疗者(替罗非班组)54例,未联合替罗非班治疗者(对照组)54例。比较两组间临床特征、PCI术前及术后TIMI分级、PCI术后TIMI心肌灌注分级(TMPG)、术后2 h心电图ST段回落百分比(sumSTR)及QT离散度(QTd),并观察出血并发症。结果治疗前两组患者临床基本情况无显著差异。替罗非班组PCI术前TIMI3级获得率较对照组明显增高(29.63%vs 11.11%,P=0.03),术后TIMI3级获得率差异无统计学意义。替罗非班组术后TMPG 3级获得率(94.44%vs 74.07%,P=0.01)、术后2 h ST段完全回落率(88.89%vs 68.52%,P=0.02)均明显高于对照组。术后2 h QT离散度替罗非班组明显低于对照组(24.80±4.26 vs 51.11±8.91,P<0.001)。替罗非班组轻微出血发生率有高于对照组趋势(9.26%vs 3.70%,P=0.43),但无严重出血或血小板减少症。结论国产替罗非班可提高急性STEMI急诊行经皮冠PCI术后心肌组织灌注,且安全可行。 Objective To investigate the effect of platelet glycoprotein IIb/IIIa receptor blockade with tirofiban on myocardial perfusion after primary percutaneous coronary intervention（PCI） in patients with ST-segment elevated myocardial infarction（STEMI） at early stage.Methods One hundred and eight patients with acute STEMI for the first time receiving successful primary PCI through radial artery in CCU of Yuncheng Central Hospital from May 2007 to November 2010 were enrolled.All the patients were grouped into tirofiban group（n=54）and control group（n=54） according to the use of tirofiban or not.The clinical features and TIMI grading before and after PCI were compared.TIMI myocardial perfusion grading（TMPG）,the sum of ST-segment elevation（sumSTR） and QT dispersion（QTd） in 2 h after PCI were recorded and compared.Bleeding complications were also observed.Results Clinical baseline before treatment was similar in two groups.The rate of TIMI3 was higher in tirofiban group than in control group before operation（29.63% vs 11.11%,P=0.03）,while the rate of TIMI3 was not significantly different between 2 groups after PCI.In tirofiban group the rates of TMPG3 and sumSTR were higher than in control group after PCI（TMPG3：94.44% vs 74.07%,P=0.01;sumSTR：88.89% vs 68.52%,P=0.02）.Compared with control group,QT dispersion decreased significantly in tirofiban group（51.11±8.91 vs 24.80±4.26,P〈0.001）.The rate of minor bleeding complications in tirofiban group was higher than in control group,but there was no significant difference（9.26% vs 3.70%,P=0.43）.No patient had major bleeding or thrombocytopenia.Conclusion Tirofiban can further improve the microvascular perfusion,and it is safe and feasible for patients with acute ST-segment elevated myocardial infarction undergoing primary PCI.

作者李颖佳屈艳玲

机构地区运城市中心医院心血管内科

出处《山西医科大学学报》 CAS 2011年第4期311-314,共4页 Journal of Shanxi Medical University

关键词心肌梗死经皮冠状动脉替罗非班心肌灌注 myocardial infarction percutaneous coronary tirofiban myocardial perfusion

分类号 R542.22 [医药卫生—心血管疾病]

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