摘要
目的:探讨早期应用不同剂量替罗非班对急性ST段抬高型心肌梗死(STEMI)患者的临床疗效和安全性。方法:选取急诊行冠状动脉支架植入术(PCI)的103例STEMI患者,按照随机数字表法,根据给药时间分为早期给药组(67例)和晚期给药组(36例),早期给药组根据药物剂量又分为低剂量组(33例)和常规剂量组(34例)。观察3组患者术前、术后梗死相关血管TIMI血流分级,术后90 min ST段抬高回落百分比,心肌损伤标志物变化,术后7 d内出血事件及30 d内心血管不良事件发生率。结果:(1)3组术后TIMI 3级血流患者比例均显著高于术前(均P<0.05),早期给药组TIMI 3级血流比例显著高于晚期给药组(P<0.05)。(2)早期给药组90 min ST段回落百分比明显高于晚期给药组(P<0.05),而早期两组组间比较无差异(P>0.05)。(3)与晚期给药组相比,早期给药组可显著降低术后血清肌酸激酶同工酶水平(P<0.05),但3组术后肌钙蛋白水平无明显差异(P>0.05)。(4)3组主要心血管事件(MACE)发生率无明显差异(P>0.05),低剂量组出血发生率低于常规剂量组(P<0.05),而血小板减少发生率无明显差异(P>0.05)。结论:早期应用替罗非班可改善急性STEMI患者PCI术后心肌血流的再灌注,且未增加临床不良事件的发生风险。低剂量与常规剂量相比,疗效相当,且出血发生率更低,安全性更高。
Objective： To evaluate the clinical effect and safety of early application of different doses of tirofiban in patients with acute ST- segment elevation myocardial infarction （STEMI）. Methods： One hundred and three cases of patients with STEMI receiving emergency coronary stenting were randomized into early administration of tirofiban group （n=67）and later administration group （n=36）according to the time of drug administration;The early administration group was divided into low dose group （33 cases） and conventional dose group （34 cases） .The TIMI flow classification, the percentage of ST segment depression at 90 min, myocardial markers, 7-day bleeding events and 30-day adverse cardiovascular events were observed and compared among the three groups before and after operation. Results： （ 1 ）The TIMI 3 flow grade after operation in the three groups were significantly higher than those before operation （P〈O.05）, and the proportion of the TIMI 3 grade flow in the early administration group was significant higher than that in the later administration group （P〈0.05）. （2）The percentage of ST segment depression at 90 min in the early administration group was significantly higher than that in the later treatment group （P〈0.05）, and the former two groups had no significant difference （P〉0.05）.（3）Compared with the later administration group, the levels of CK-MB in the early treatment group decreased significantly （P〈0.05）,but the cTnI levels had no significant differences in the three groups （P〉0.05）.（4）The incidence of major cardiovascular events （MACE） in the three groups presented no significant differences （P〉0.05）. The hemorrhage incidence in low dose group was significantly lower than that in conventional dose group （P〈0.05）, but thrombocytopenia occurred rate had no significant difference （P〉0.05）. Conclusion：Early application of tirofiban could significantly improve myocardial reperfusion and clinical outcomes in patients with STEMI undergoing PCI. Compared with the conventional dose, the bleeding incidence of low dose is lower, and the safety is higher.
出处
《天津医科大学学报》
2017年第1期59-62,共4页
Journal of Tianjin Medical University
关键词
急性ST段抬高型心肌梗死
替罗非班
冠状动脉介入治疗
心肌再灌注
acute ST-segment elevation myocardial infarction
tirofiban
percutaneous coronary intervention
myocardial reperfusion
