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目的探讨使用替罗非班的时机对急性ST段抬高性心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)疗效的影响。方法 104例STEMI患者随机分为提前治疗组(n=55)和术中治疗组(n=51),分别在急诊室内和造影后行PCI前静脉弹丸注射替罗非班10μg·kg~(-1),之后维持0.15μg·kg~(-1)·min~(-1)静脉泵入24h。比较2组患者术前和术后梗死相关冠状动脉血流复流情况、术后1h最高导联的ST段回落率、术后1wk左室射血分数(LVEF)及左室舒张末内径(LVDd)、30d内主要心血管事件(MACE)、出血事件和死亡率等指标。结果与术中治疗组相比,提早治疗组冠状动脉造影时无血流的比例低(TIM10级62%vs.80%),术中发生无再流率低(5%vs.20%),最高导联的ST段70%回落发生率高(53%vs.33%),术后1wk心脏超声LVEF值高、LVDd值低(均P<0.05)。2组间30d内MACE、死亡及术后出血发生率无显著差异(P>0.05)。结论 STEMI患者行急诊PCI时,早期联合使用替罗非班能改善PCI手术疗效,对早期心功能的改善有益,且并未增加出血风险。
Objective To investigate the effect of tirofiban in the treatment of acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods One hundred and four patients with STEMI were randomly divided into two groups: pretreatment group (n = 55) and intraoperative treatment group (n = 51). Tirofiban 10 μg · kg ~ (- 1), and then maintained at 0.15μg · kg -1 (-1) min -1 for 24 h. Preoperative and postoperative infarction-related coronary blood flow resuscitation was compared between the two groups. The highest lead ST segment resolution at 1 hour after operation, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVDd) ), Major cardiovascular events within 30 days (MACE), bleeding events and mortality and other indicators. Results Compared with the treatment group, the rate of no blood flow during coronary angiography was lower in the early treatment group (TIM10 grade 62% vs. 80%), no recurrence rate (5% vs. 20%), The incidence of 70% fallback in the ST lead segment was highest (53% vs.33%) in the highest lead, and the LVEF value and LVDd value were significantly lower at 1wk after operation (all P <0.05). There was no significant difference in the incidence of death and postoperative bleeding between the two groups within 30 days (P> 0.05). Conclusions The early combined use of tirofiban in STEMI patients undergoing PCI can improve the curative effect of PCI and improve the early cardiac function without increasing the risk of bleeding.