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目的:探讨在急性冠脉综合征(ACS)患者病程中常规治疗联合应用盐酸替罗非班对心肌组织水平再灌注与围PCI术期严重心脏不良事件(MACE)的影响。方法:2005—2006年间15例在急诊或择期PCI术前具有形成血栓的高危因素或PCI术时发现慢血流现象或血栓的ACS患者,在术前、术中或术后应用盐酸替罗非班,按推荐剂量经外周静脉或冠脉内直接注入药物,观察15～20min后相关血管的血栓征象、血栓负荷、TIMI分级情况、术后MACE及出血并发症等。结果:15例ACS患者,男性13例,女性2例,年龄44～75岁,起病时间在数小时至数天。全部患者术中即刻造影均未见有明显的新发血栓形成,原有新鲜血栓消失,肇事血管前向血流由TIMI0～2级恢复至TIMI3级。术后14例患者术后一般情况稳定,症状明显改善或消失,住院期间未发生MACE与出血并发症,但有1例患者在住院期间因心源性休克、多器官功能衰竭死亡。结论:对ACS介入治疗围手术期存有靶血管高危因素存在(如慢血流、血栓等征象)的患者,经冠脉或外周静脉应用盐酸替罗非班有助于改善心肌组织再灌注水平,减少围手术期血栓并发症所致的MACE发生。
Objective: To investigate the effects of conventional therapy combined with tirofiban hydrochloride on myocardial tissue reperfusion and perioperative severe cardiac events (MACE) in patients with acute coronary syndrome (ACS). Methods: Between 2005 and 2006, 15 patients with risk factors of thrombosis before emergency or elective PCI or ACS patients with slow blood flow or thrombus at PCI were treated with Tirofibrate Hydrochloride before, during or after operation Class, according to the recommended dose by peripheral vein or coronary injection of drugs directly observed after 15 ~ 20min thrombosis related blood vessels, thrombus load, TIMI grading, postoperative MACE and bleeding complications. Results: Fifteen ACS patients, 13 males and 2 females, aged 44 to 75 years old, the onset time in a few hours to several days. All patients underwent immediate angiography showed no significant new thrombosis, the original fresh thrombus disappeared, the antegrade blood flow from TIMI0 ~ 2 level to TIMI3 level. Postoperative 14 patients were generally stable after surgery, symptoms improved or disappeared, MACE and bleeding complications did not occur during hospitalization, but 1 patient died of cardiogenic shock and multiple organ failure during hospitalization. CONCLUSIONS: Tirofiban hydrochloride administered via coronary artery or peripheral vein may improve myocardial reperfusion level in patients undergoing percutaneous coronary intervention who are at risk for target vascular disease (eg, slow blood flow, thrombosis, etc.) , Reduce perioperative complications caused by thrombus MACE.