摘要
目的:用血栓弹力图评价半量替罗非班治疗高龄急性冠脉综合征(ACS)患者的效果。方法:行急诊经皮冠状动脉介入术的高龄ACS患者126例被随机分为替罗非班半量组和全量组,各63例。两组均常规应用阿司匹林、氯吡格雷,手术前开始应用替罗非班。监测两组术前、术后12h的血栓弹力图变化。观察两组住院期间的不良反应(出血、血小板减少)及30d内的主要心血管事件(死亡、再梗死、靶血管重建、亚急性支架内血栓形成)。结果:与术前比较,两组术后12hα角[半量组:(61.3±14.7)°比(38.5±8.2)°,全量组:(58.7±12.8)°比(36.1±5.7)°]、曲线最大幅度(MA值)[半量组:(49.3±17.8)mm比(24.8±12.5)mm,全量组:(54.2±1 9.6)mm比(21.4±13.6)mm]均显著下降(P均<0.01);二磷酸腺苷(ADP)诱导的血小板抑制率[半量组:(27.5±14.3)%比(69.3±18.2)%,全量组:(32.4±15.2)%比(72.6±20.3)%]显著增加(P<0.01)。术前及术后12h两组间各血栓弹力图参数比较无显著差异(P>0.05)。住院期间两组出血事件发生率(11.1%比17.5%)和血小板减少发生率(9.5%比11.1%),全量组轻度增多,但无显著差异(P>0.05)。随访期间两组主要心血管事件发生率无显著差异(15.9%比14.3%,P>0.05)。结论:行急诊经皮冠状动脉介入术治疗的高龄急性冠脉综合征患者,半量替罗非班相对安全、有效,值得临床推荐。
Objective： To evaluate the effect of semis tirofiban by thrombelastogram （TEG） in advanced aged patients with acute coronary syndrome （ACS）. Methods： A total of 126 advanced aged ACS patients undergoing emergency percutaneous coronary intervention （PCI） were randomly and equally divided into semis group and full dose group for tirofiba treatment. Both groups routinely received aspirin and clopidogrel, and received tirofiban before PCI. TEG change was monitored in two groups before and 12h after PCI. Adverse reactions during admission （hemorrhage and thrombocytopenia） and major cardiovascular events （death, reinfarction, target vessel revascularization and subacute thrombosis in stent） within 30d were observed in two groups. Results： Compared with before PCI, there were significant decrease in a angle Esemis group： （61. 3 ±14. 7）° vs. （38.5±8.2）°, full dose group： （58. 7±12.8）°vs. （36.1 ＋ 5.7）°] and maximum amplitude [MA, semis group： （49.3 ±17.8） mm vs. （24. 8 ±12.5） mm, full dose group： （54. 2 ±19.6） mm vs. （21.4 ±13.6） mm], and significant increase in adenyl diphosphoric acid （ADP） induced platelet inhibition rate [semis dose group： （27. 5 ±14. 3）% vs. （69.3 ±18. 2）%, full dose group： （32. 4±15.2）% vs. （72.6±20. 3）%] in both groups 12h after PCI, P〈0. 01 all. There Were no significant difference in all TEG indexes between two groups before and 12h after PCI, P〈0.05. Compared with semis group, there were slight increase in incidence rates of hemorrhage （11.1% vs. 17.5%） and thrombocytopenia （9.5% vs. 11.1%）, but no significant difference （P〉0.05） during admission in full dose group. There was no significant difference in incidence rate of major adverse cardiovascular events （15.9% vs. 14. 3%, P〉0.05） during follow up between semis group and full dose group. Conclusion： Semis tirofiban is relatively safe and effective in advanced aged patients with acute coronary syndrome undergoing emergency percutaneous Coronary intervention, and may be worth extending in clinic.
出处
《心血管康复医学杂志》
CAS
2013年第6期586-589,共4页
Chinese Journal of Cardiovascular Rehabilitation Medicine
基金
首都医学发展科研基金(2009-3244)
