摘要
目的：探讨冠状动脉（冠脉）内应用Ⅱb／Ⅲa受体拮抗剂替罗非班在急性ST段抬高型心肌梗死（STEMI）老年患者（≥75岁）急诊经皮冠脉介入（PPCI）治疗中的疗效及安全性。方法：入选因STEMI行PPCI的老年患者104例，随机分为替罗非班组及对照组。主要临床终点是PPCI术后心肌微循环灌注水平，次要临床终点是：①住院期间不良事件（死亡、再梗死、靶血管重建和脑卒中）；②B型脑利钠肽（BNP），左室射血分数（LVEF）及左室舒张末期内径（LVDd）；③出血及消化道不良症状。结果：替罗非班组术后心肌微循环灌注水平明显高于对照组（MBG2～3级：79．63％。58．00％，P〈0．05）；替罗非班组与对照组入院时BNP无明显差异，入院1周时替罗非班组BNP低于对照组[（117．5士23．50）ng／ml：（245．1±27．11）ng／ml，P〈0．01]，替罗非班组LVEF值高于对照组[（57．13土7．37）％：（51．19士5．68）％，P〈0．05]，两组LVDd差异无统计学意义；两组住院期间不良事件发生率、严重及中度出血发生率及消化道不良症状发生率差异无统计学意义；替罗非班组轻度出血发生率高于对照组（16．67％：4．00％，P〈0．05）。结论：老年STEMI患者冠脉内应用替罗非班可提高心肌微循环灌注水平，不增加严重出血事件，但应注意观察轻度出血事件。
Objective：To investigate the efficacy and safety of intracoronary tirofiban administration during pri- mary percutaneous coronary intervention （PPCI） in aged （〉j75 years） patients with ST-segment elevation myocar- dial infarction （STEMI）. Method：A total of 104 aged STEMI patients treated with PPCI were randomly divided into tirofiban group and control group. The primary endpoint was myocardial tissue-level perfusion assessed bymyocardial blush grade （MBG）. The secondary endpoint was： （I） major adverse cardiac events （MACE） including sudden death, reinfarction, target vessel revascularization and stroke during hospitalization; B-type natriuretic peptide （BNP）, left ventricular ejection fraction （LVEF） and left ventricular end diastolic dimension （LVDd）! bleeding complications during hospitalization. Result： Tirofiban group had a higher myocardial tissue perfusion than eontrol group （MBG 2--3： 79.63% vs 58. 00%, P〈0. 05）. In tirofiban group, BNP level was lower than that in control group [（117.54-23.50）ng/ml vs （245.1±27.11）ng/ml, P〈0.01] and LVEF was higher [（57.13 ±7.37） % vs （51.19-4-5.68）, P〈0.05] 1 week after admission. There was no significant difference in BNP the admission day and LVDd after a week. The incidences of MACE and major or moderate bleeding event were similar between the two groups. The incidenee of mild bleeding in tirofiban group was higher than that in control group （16.67% vs 4.00%, P〈0.05）. The incidences of gastrointestinal adverse symptoms were similar between the two groups. Conclusion： Intracoronary administration of tirofiban in aged STEMI patients undergoing PPCI could improve myocardial tissue perfusion without increasing major bleeding event. However, careful attention should he paid to the possible mild bleeding.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2014年第4期324-327,共4页
Journal of Clinical Cardiology
基金
上海市科委国际合作项目(No:12410708300)
