论文部分内容阅读
目的探讨急性 ST 段抬高心肌梗死急诊 PCI 时国产替罗非班的不同应用途径(静脉内/冠状动脉内)对心肌组织水平灌注与临床预后影响的差异。方法连续选择60例急性 ST 段抬高心肌梗死拟行急诊 PCI 的患者,随机分为替罗非班静脉内应用组(静脉组,n=30)与替罗非班冠状动脉内应用组(冠状动脉组,n=30),比较两组术后即刻造影结果、住院期间以及随访期间主要不良心脏事件(MACE)发生的差异。结果共有54例完成试验,其中男性43例,女性11例,年龄29～75(58.80±12.57)岁,冠状动脉组在术后心外膜 TIMI 分级、TIMI 心肌灌注分级(TIMI MyocardialPerfusion,TMP)、心电图 ST 段回落、梗死相关血管远端末梢栓塞、以及治疗后5～7天的心脏彩超射血分数值、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)等方面均显著优于静脉组,虽然心脏肌钙蛋白 I(cTnI)与肌酸激酶同工酶(CK-MB)峰值浓度两组无差异,但是冠状动脉组 CK-MB 达峰值的时间显著缩短,两组院内 MACE 事件发生未达到统计学差异,平均住院日亦相同,但是30～90(平均57±21)天随访期间冠状动脉组总的 MACE 事件发生显著少于静脉组(7.1%与30.8%,P=0.02)。应用 Cox 回归比例风险模型在校正年龄、性别、高血压、糖尿病、家族史、吸烟等危险因素以及心肌梗死部位、胸痛至球囊扩张时间后,计算冠状动脉组在平均57天随访期间发生总的 MACE 事件的相对危险度为0.14(P=0.03)。冠状动脉组发生轻度出血与严重出血并发症有增多的趋势,但未达到统计学差异。结论对于急性 ST 段抬高心肌梗死行急诊 PCI 治疗的患者,冠状动脉内应用替罗非班安全、有效,与静脉内应用相比可以进一步改善心肌水平再灌注状态并能提高临床预后,这对于在急诊室因为各种原因未能提前应用替罗非班的患者来说具有特殊的临床意义。
Objective To investigate the differences in the effects of different routes of application of tirofiban (intravenous / intracoronary) on myocardial perfusion and clinical prognosis in patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI. Methods Sixty consecutive patients with acute ST-segment elevation myocardial infarction who underwent emergency PCI were enrolled and randomly assigned to receive either tirofiban intravenous (n = 30) or tirofiban (n = 30) Arterial group, n = 30). The difference of immediate adverse cardiac events (MACE) between the two groups was compared between the two groups immediately after surgery, during hospitalization and during follow-up. Results A total of 54 patients completed the trial, 43 were male and 11 were female, ranging in age from 29 to 75 (58.80 ± 12.57) years. TIMI grade, TIMI myocardial infarction rate (TIMI) ECG ST segment depression, distal infarction-related vascular distal embolization, and 5 to 7 days after treatment of echocardiographic ejection fraction, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) were significantly better In the venous group, although the peak concentrations of cTnI and CK-MB were not significantly different between the two groups, the peak time of CK-MB in the coronary artery group was significantly shortened. The MACE The events did not reach statistical significance and the average length of stay was also the same, but the total MACE events in the coronary artery group were significantly less than those in the intravenous group during 30 to 90 (mean 57 ± 21) days of follow-up (7.1% vs. 30.8%, P = 0.02 ). Cox Regression Proportional Hazard Model The cumulative incidence of coronary artery disease during an average of 57 days of follow-up was calculated after adjusting for risk factors such as age, gender, hypertension, diabetes, family history, smoking, and myocardial infarction, chest pain to balloon dilation The relative risk level for MACE events was 0.14 (P = 0.03). The incidence of mild bleeding and severe bleeding in the coronary artery group tended to increase, but did not reach statistical significance. CONCLUSIONS: Tirofiban is safe and effective in patients with acute ST-segment elevation myocardial infarction undergoing emergency PCI and may improve myocardial reperfusion status and improve clinical outcome compared with intravenous administration, It is of particular clinical significance in emergency departments to fail to advance the application of tirofiban for various reasons.