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目的:观察替罗非班在急性心肌梗死(AMI)经皮行冠状动脉介入治疗(PCI)中的临床价值。方法:68例急性心肌梗死行PCI患者随机分为替罗非班组(PCI+替罗非班,28例)和对照组(PCI,40例),均于发病12 h内行急诊PCI术。PCI术前服用氯吡格雷300~600 mg,阿司匹林300 mg,术后各75 mg.d-1,PCI术中均给予肝素8 000~10 000 U。替罗非班组PCI术中冠脉内注入盐酸替罗非班10μg.kg-1,静脉维持量0.15μg.kg-1.min-124~36 h。观察两组PCI术后即刻梗死相关血管(IRA)心肌梗死溶栓(TIMI分级)血流情况,术后30天内出血并发症及主要不良心脏事件(MACE)的发生情况。结果:替罗非班组TIMI 3级血流96.4%(27/28),对照组82.5%(33/40)(P<0.05);主要不良心脏事件的发生率替罗非班组7.1%(2/28),对照组17.5%(7/40)(P<0.05);出血并发症发生率两组比较无统计学意义(P>0.05)。结论:在急性心肌梗死介入治疗中,应用盐酸替罗非班能改善急性心肌梗死患者PCI术后梗死相关血管的TIMI血流,减少PCI术后主要不良心脏事件的发生率,临床应用安全有效。
Objective: To observe the clinical value of tirofiban in percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). Methods: 68 patients with acute myocardial infarction undergoing PCI were randomly divided into Tirofiban (PCI + Tirofiban, 28 cases) and control group (PCI, 40 cases). All of them were performed PCI within 12 hours after onset of PCI. Clopidogrel before taking 300 ~ 600 mg of PCI, aspirin 300 mg, 75 mg.d-1 after surgery, were given heparin 8,000 to 10,000 U. Tirofiban group PCI intracoronary infusion of tirofiban 10μg.kg-1, intravenous maintenance 0.15μg.kg-1.min-124 ~ 36h. The blood flow of thrombolytic (TIMI grade) infarction-related artery (IRI) myocardial infarction immediately after PCI and the incidence of bleeding complications and major adverse cardiac events (MACE) within 30 days after operation were observed. Results: TIMI grade 3 blood flow in Tilofiban group was 96.4% (27/28) in the control group and 82.5% (33/40) in the control group (P <0.05). The incidence of major adverse cardiac events was 7.1% (2 / 28), 17.5% (7/40) in the control group (P <0.05). The incidence of hemorrhagic complications was no significant difference between the two groups (P> 0.05). Conclusion: Tirofiban hydrochloride can improve the TIMI blood flow in patients with acute myocardial infarction after PCI and reduce the incidence of major adverse cardiac events after PCI in the interventional therapy of acute myocardial infarction. The clinical application is safe and effective.