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目的:比较高危非ST段抬高急性冠脉综合征(NSTE-ACS)冠脉介入治疗(PCI)术前早期应用和术前即刻应用替罗非班对PCI术后心肌损伤和血小板功能的影响,评价两种应用时机的优势。方法:160例预行PCI的高危NSTE-ACS患者随机分为PCI术前早期应用替罗非班组(治疗1组,冠脉造影前4~6 h应用替罗非班)和PCI术前即刻应用替罗非班组(治疗2组,导丝通过冠脉病变后应用替罗非班)。测定PCI术前和术后血清肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB),测定入院后、冠脉造影前和PCI术后血小板聚集率,记录使用替罗非班治疗期间的出血并发症和血小板减少症的发生率。结果:治疗1组PCI术后48 h内cTnI的峰值、累积释放值和阳性例数均显著低于治疗2组(P<0.05);两组PCI术后48 h内CK-MB的峰值、累积释放值和阳性例数比较差异均无显著性(P>0.05)。应用替罗非班后,两组血小板聚集率均显著降低(P<0.05),治疗1组冠脉造影前的血小板聚集率显著低于治疗2组(P<0.05)。在使用替罗非班治疗期间,两组重度出血并发症发生率比较差异无显著性(P>0.05),中度出血并发症和轻度血小板减少症发生率均为1.25%。结论:在阿司匹林、氯吡格雷抗血小板治疗的基础上,高危NSTE-ACS患者PCI术前早期应用替罗非班,能够更早强化抗血小板治疗效果,明显减少PCI术后微量心肌损伤。
OBJECTIVE: To compare the effect of early preoperative application and immediate application of tirofiban on myocardial injury and platelet function after percutaneous coronary intervention (PCI) in high-risk non-ST segment elevation acute coronary syndromes (NSTE-ACS) , To evaluate the advantages of two application opportunities. Methods: One hundred and sixty patients with high risk NSTE-ACS who underwent PCI were randomly assigned to receive tirofiban (PCI, Tirofiban 4 to 6 h before coronary angiography) and PCI immediately before PCI Tirofiban group (treatment group 2, application of tirofiban after the guide wire passed the coronary lesion). Serum troponin I (cTnI) and creatine kinase isoenzyme (CK-MB) levels were measured before and after PCI. Pre-PCI and post-PCI platelet aggregation rates were recorded and recorded using tirofiban Bleeding complications and thrombocytopenia during treatment. Results: The peak, cumulative release and positive cases of cTnI in 48 h after PCI were significantly lower in treatment group 1 than those in treatment group 2 (P <0.05). The peak and cumulative values of CK-MB in two groups within 48 h There was no significant difference between the release value and the positive cases (P> 0.05). After applying tirofiban, the platelet aggregation rate was significantly lower in both groups (P <0.05), and the platelet aggregation rate in the treatment group 1 before coronary angiography was significantly lower than that in the treatment group 2 (P <0.05). There was no significant difference in the incidence of severe bleeding between the two groups (P> 0.05). The incidences of moderate bleeding complications and mild thrombocytopenia were both 1.25%. Conclusion: In the aspirin, clopidogrel antiplatelet therapy, based on the high-risk patients with NSTE-ACS before PCI Tirofiban early treatment, can be an earlier anti-platelet therapy and significantly reduce myocardial percutaneous myocardial injury.