摘要
目的:探讨导管室上游应用替罗非班对中高危非ST段抬高急性冠状动脉综合征(NSTACS)患者血运重建术后凝血纤溶系统的影响。方法:80例中高危NSTACS患者均择期接受冠状动脉介入术(PCI)治疗,分为上游组(PCI前应用替罗非班,n=38例)和下游组(PCI开始时应用替罗非班,n=42例),观察术前及术后24小时血浆凝血酶原时间(PT)、D二聚体、纤维蛋白原(FBG)和纤溶酶原激活物抑制物-1(PAI-1),观察两组靶血管血流灌注及院内、30天主要心血管不良事件和出血事件。结果:与基线水平比较,两组患者术后血清PAI-1水平均显著低于基线水平[上游组(11.8±3.2)vs.(9.7±2.7)ng/L,P=0.003;下游组(11.0±1.1)vs.(10.1±1.6)ng/L,P=0.020],上游组术后PAI-1水平显著低于下游组[(9.7±2.7)vs.(10.1±1.6)ng/L,P=0.039]。两组术前术后PT、DD和FBG未见明显差异(P>0.05),两组患者出血事件差异有统计学意义(P>0.05)。上游组术后靶血管TMPG分级<3的比例明显低于下游组(P=0.023);两组患者院内和30天心血管不良事件未见有意义统计学差异(P>0.05)。结论:替罗非班可通过调节纤溶系统,改善接受PCI治疗的中高危NSTSCA患者血栓高负荷状态,部分改善靶血管的血流灌注,导管室上游应用效果或更显著,且未见明显增加出血事件。
Objective： to analyze the effect of the upstream application of tirofiban on coagulative and fi- brinolytic system in the middle-high risk patients of non-ST acute coronary system（ non-ST ACS） after pereuta- neous coronary intervention（PCI）. Methods：80 patient received （PCI）with non-ST ACS were divided into 2 groups ： the upstream group （ n = 38 ） and the downstream group （ n = 42 ）, to observe the plasma level of pro- thrombin time （ pT）, d-dimer （ DD ）, fibrinogen （ FBG）, plasminogen activator inhibitor （ PAI-1 ） ） before and after PCI 24 hours, to observe the bleeding events between the two groups. Result： The serum level of PAI-1 after PCI 24 hours was significantly lower than before PCI in the two groups separately[ the upstream group： （11.8 ± 3.2） vs. （9.7±2.7）ng/L,P=0.003;the downstream group： （11.0±1.1） vs. （10.1 ±1. 6）ng/L,P= 0. 020]. The serum level of PAI-1 after PCI 24 hours in the upstream group was significantly lower than in the downstream group [ （9. 7± 2. 7 ） vs. （ 10. 1± 1.6） ng/L,P = 0. 039 ] after PCI 24 hours in the upstream group was significantly lower than that of the downstream group. There were no significant difference of the serum lev- els of PT,DD,FBG before or after PCI 24 hours between the two groups（P 〉0. 05）. The rate of TIMI myocar- dial perfusion grade（TMPG） 〈 3 of target vessels after PCI was higher in the upstream group than in the down- stream group （P = 0. 023 ）. There was no significant difference of MACE between the two groups in hospital and30days after PCI（ P 〉 0. 05 ）. There were no significant difference of the bleeding events between the two groups （P 〉 0.05）. Conclusion ：Tirofiban may improve the thrombosis overload status and myocardial perfusion of target vassels, partly due to regulation of fibrinolytic system, especially by upstream using tirofiban before PCI in the middle-high risk patients of NSTACS, and the bleeding events were not increase.
出处
《心肺血管病杂志》
2016年第1期6-9,24,共5页
Journal of Cardiovascular and Pulmonary Diseases
基金
北京市医院管理局临床技术创新项目(XMLX201406)
