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目的探讨冠脉内注射高剂量替罗非班对急性ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入(PCI)治疗术后体表心电图出现碎裂QRS波(f QRS)的影响。方法连续入选150例接受直接PCI治疗的急性STEMI患者,随机分成冠脉内注射高剂量替罗非班组(替罗非班组,n=75)和常规治疗组(n=75),观察住院48 h内体表心电图f QRS的发生率以及术后住院期间主要不良心脏事件(MACE)。结果两组临床基本特征无显著差别。替罗非班组术后校正的TIMI帧数(CTFC)较常规组少[(23±7)帧vs.(30±10)帧,P<0.05];肌酸激酶同工酶(CK-MB)峰值浓度显著低于常规治疗组[(245±162)U/L vs.(311±180)U/L,P<0.05],而左心室射血分数(LVEF)值则显著高于常规治疗组[(51±6)%vs.(47±7)%,P<0.05],同时,术后替罗非班组和常规治疗组f QRS发生率分别41%(30/75)和57%(43/75),两组之间比较差异显著,P<0.05)。两组住院期间MACE事件有差异,但未达到统计学意义(5%vs.12%)。结论冠脉注射高剂量替罗非班能改善心肌灌注,降低术后体表心电图f QRS发生率,提高心脏功能。
Objective To investigate the effect of intracoronary injection of high dose tirofiban on fragmented QRS wave (F QRS) of postoperative epicardial electrocardiogram in patients with acute ST-elevation myocardial infarction (STEMI) undergoing direct percutaneous coronary intervention (PCI) . Methods A total of 150 acute STEMI patients undergoing direct PCI were enrolled in this study. Patients were randomly divided into high dose of tirofiban group (tirofiban, n = 75) and routine treatment group (n = 75) The incidence of endocardial electrocardiogram f QRS and postoperative major adverse cardiac events (MACE) during hospitalization. Results There was no significant difference between the two groups in clinical features. The postoperative corrected TIMI frames (CTFCs) in tirofiban group were less than that in the conventional group [(23 ± 7) frames vs. (30 ± 10) frames, P <0.05] (245 ± 162) U / L vs. (311 ± 180) U / L, P <0.05], while the value of LVEF was significantly higher than that of the conventional treatment group [(51 ± 6)% vs (47 ± 7)%, P <0.05]. Meanwhile, the incidence of f QRS in the tirofiban group and the conventional treatment group was 41% (30/75) and 57% (43% / 75), significant difference between the two groups, P <0.05). There was a difference in MACE events between the two groups during hospitalization but did not reach statistical significance (5% vs. 12%). Conclusion Coronary injection of high dose tirofiban can improve myocardial perfusion, reduce the incidence of postoperative surface ECG f QRS and improve cardiac function.