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目的探讨急性sT段抬高心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)前后,应用血小板糖蛋白(GP)IIb／IIIa受体拮抗剂替罗非班的安全性,以及对急诊PCI再灌注的疗效和近中期预后的影响。方法选择2006年4月至2007年3月急性STEMI接受急诊PCI治疗的76例患者,男57例,女19例,年龄34-89岁,年龄为(65±17)岁。将其随机分为两组,治疗组,38例,在急诊PCI前至少半小时开始使用替罗非班;空白对照组,38例,其中8例因术中发现冠状动脉内血栓负荷较重临时转入治疗组;实际空白对照组为30例,治疗组为46例。比较两组的基础临床情况、术前梗死相关血管(IRA)前向TIMI血流情况,术后TIMI血流情况,以及出血事件、近期(1个月)和中期(6个月)心血管事件(MACE)发生情况和心功能恢复情况。结果两组基础情况(包括年龄、性别、介入干预时间)的差异均无统计学意义(P值均>0．05),治疗组术前IRA出现前向血流(TIMI 1级以上)的比率为17．39％,略大于空白对照组的14．51％,但差异无统计学意义(P>0．05)。治疗组术后TIMI 3级的获得率为96％,显著高于对照组的87％(P<0．05)．根据实际分组统计,治疗组术后TIMI 3级的获得率为88％,反低于空白对照组的91％,但差异无统计学意义(P>0．05)。两组近期MACE、出血事件及血小板减少症发生率的差异均无统计学意义(P值均>0．05)。对已完成中期随访的47例患者进行分析,6个月时,两组的左室收缩功能(LVEF)、左室舒张末压(LVEDD)和MACE的差异均无统计学意义(P值均>0．05)。结论急性STEMI患者急诊PCI前使用替罗非班是安全的:术前提前(至少半小时)使用替罗非班可以提高术后IRA的前向TIMI血流,减少术后无复流的发生,术中发现无复流后再追加使用替罗非班并不能提高患者近中期的预后。
Objective To investigate the safety of the platelet glycoprotein (GP) IIb / IIIa receptor antagonist, tirofiban, before and after emergency percutaneous coronary intervention (PCI) in acute ST segment elevation myocardial infarction (STEMI) Effect of PCI Reperfusion and Prognosis in Near and Middle. Methods From April 2006 to March 2007, 76 patients with acute STEMI undergoing emergency PCI were 57 males and 19 females, aged 34-89 years (mean age 65 ± 17 years). The patients were randomly divided into two groups, treatment group, 38 cases. Tirofiban began to be used at least half an hour before emergency PCI. In the blank control group, 38 cases were treated, of which 8 cases were found to have severe intracoronary thrombus loading Into the treatment group; the actual control group of 30 cases, the treatment group was 46 cases. Preoperative TIMI blood flow, postoperative TIMI blood flow, and bleeding events were compared between the two groups based on clinical status, preoperative infarction related vessels (IRA), recent (1 month) and mid-term (6 months) cardiovascular events (MACE) and cardiac function recovery situation. Results There was no significant difference between the two groups (P> 0.05). There was no significant difference between the two groups (P> 0.05). The rate of preoperative IRA (TIMI level 1 or above) 17.39%, slightly larger than the control group 14.51%, but the difference was not statistically significant (P> 0.05). The postoperative TIMI grade 3 in the treatment group was 96%, which was significantly higher than that in the control group (87%, P <0.05). According to the actual grouping statistics, the acquisition rate of TIMI grade 3 in the treatment group was 88%, which was lower than 91% of the blank control group, but the difference was not statistically significant (P> 0.05). There were no significant differences in the incidence of MACE, bleeding and thrombocytopenia between the two groups (P> 0.05). Forty-seven patients who had completed a mid-term follow-up were analyzed. There was no significant difference in left ventricular systolic function (LVEF), left ventricular end-diastolic pressure (LVEDD) and MACE between the two groups at 6 months (P> 0.05). Conclusion Tirofiban is safe before emergency PCI in patients with acute STEMI: Tirofiban preoperatively (at least half an hour before surgery) can improve the anterior TIMI blood flow of postoperative IRA, reduce the incidence of postoperative no-reflow, Intraoperative recurrence found no additional use of tirofiban does not improve the prognosis of patients in the near mid-term.