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目的:比较急性心肌梗死介入治疗中冠脉内常规给予以及必要时给予血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班两种给药方式对冠脉血流异常的影响,寻找较好的替罗非班用药方式。方法:入选九四医院2005年1月至2008年10月急性心肌梗死直接PCI患者58例,随机分成常规给药组(血管开通前所有患者冠状动脉内均注射替罗非班,n=30)与必要时给药组(血管开通后即时造影显示TIMI血流≤2级者冠脉内注射替罗非班,TIMI血流3级者不给药,n=28),观察支架植入后30分钟TIMI血流、30天内主要不良心血管事件(MACE)、出血以及血小板减少情况。结果:必要给药组冠脉内给药可显著改善冠脉血流(TIMI3级给药前46.4%,给药后75%,P<0.05),常规给药组支架植入后30分钟TIMI3级获得率高于必要给药组(96.7%比75%,P<0.05),MACE、出血和血小板减少事件两组之间差异无统计学意义。结论:冠脉内给予替罗非班可有效降低急性心肌梗死PCI术中血流异常情况,血管开通前冠脉内常规给药方式优于必要时给药方式。
OBJECTIVE: To compare the effects of routine administration of coronary intracoronary infusion of acute myocardial infarction (AMI) and the administration of tirofiban, a platelet glycoprotein (GP) IIb / IIIa receptor antagonist, on coronary blood flow abnormalities, Find better tirofiban medication. Methods: Fifty-eight patients with acute myocardial infarction (PCI) from January 1994 to October 2008 in the 94 Hospital were randomly divided into routine treatment group (all patients were injected with tirofiban before coronary artery occlusion, n = 30) And when necessary, the administration group (blood vessels immediately after angiography showed TIMI flow ≤ 2 intracoronary injection of tirofiban, TIMI blood flow grade 3 were not given, n = 28), observed after stent implantation 30 Minute TIMI flow, major adverse cardiovascular events (MACE) within 30 days, bleeding, and thrombocytopenia. Results: Coronary blood flow was significantly improved in the necessary drug-treated group (46.4% before TIMI-3 administration and 75% after administration, P <0.05). In the conventional drug-treated group, TIMI3 level (96.7% vs 75%, P <0.05). There was no significant difference in MACE, hemorrhage and thrombocytopenia between the two groups. CONCLUSION: Intracoronary administration of tirofiban can effectively reduce the abnormal blood flow in PCI during acute myocardial infarction. The intracoronary administration mode before administration of the blood vessel is superior to the administration mode when necessary.