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目的观察替罗非班对急性ST段抬高性心肌梗死(STEMI)患者在比伐卢定抗凝下直接经皮冠状动脉介入治疗(PCI)中出现无复流或慢血流的疗效。方法 87例STEMI患者在比伐卢定抗凝下直接PCI术中出现无复流或慢血流,均给予硝酸甘油冠脉内推注,仍无复流或慢血流的患者随机冠脉内给予替罗非班10μg·kg-1(治疗组,n=44)或肝素盐水20 m L(8 U·m L-1,对照组,n=43),于给药后5 min时复查造影,观察两组梗塞相关血管的TIMI血流分级(TFG)和校正的TIMI血流帧数计数(CTFC)、出血并发症和30 d主要心血管事件(MACE)。结果给药后5 min两组TFG、CTFC比给药前显著好转(P<0.05),治疗组优于对照组(P<0.05)。两组术后出血并发症和30 d MACE发生率无显著差异(P>0.05)。结论对于STEMI患者在比伐卢定抗凝下直接PCI术中出现无复流或慢血流,冠脉内给予替罗非班效果明显且安全。
Objective To investigate the efficacy of tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing no-reflow or slow blood flow during direct percutaneous coronary intervention (PCI) under bivalirudin anticoagulation. Methods Eighty-seven patients with STEMI underwent no-reflow or slow blood flow during PCI under bivalirudin anticoagulation. All patients were given intracoronary bolus injection of nitroglycerin, and patients with no-reflow or slow blood flow were randomized to receive intracoronary The rabbits were treated with 10 mg · kg-1 of LuoFaban (treatment group, n = 44) or heparin saline 20 mL (8 U · m L-1, control group, n = 43) TIMI flow grade (TFG) and corrected TIMI flow frame count (CTFC), hemorrhagic complications, and MACD at 30 days in both infarct-related vessels. Results At 5 min after administration, TFG and CTFC in both groups were significantly improved (P <0.05), and those in the treatment group were better than those in the control group (P <0.05). There were no significant differences in postoperative bleeding complications and MACE incidence at 30 days between the two groups (P> 0.05). CONCLUSIONS: No or no blood flow is seen in patients with STEMI undergoing direct PCI under anticavage with bivalirudin. Tirofiban is given in a significant and safe manner in patients with STEMI.