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目的探讨高负荷剂量氯吡格雷联合替罗非班在高危非ST段抬高型急性冠状动脉综合征(acutecoronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)中的作用及安全性。方法 152例拟行PCI术的高危非ST段抬高型ACS患者,术前口服氯吡格雷600mg+替罗非班0.4μg/(kg.min)静脉注射30min,继以0.1μg/(kg.min)持续静脉泵入至术后36h者72例为观察组,术前仅口服氯吡格雷600mg者80例为对照组,观察PCI术后TIMI血流分级、心肌灌注、30d内主要不良心血管事件和出血并发症发生率。结果 PCI术后观察组患者心肌灌注分级TMPG 2级以上发生率(87.5%)高于对照组(72.5%)(P<0.05),观察组校正TIMI计帧数(24.70±6.60)小于对照组(27.33±6.42)(P<0.05);2组PCI术后病变血管血流TIMI 3级发生率比较差异无统计学意义(P>0.05);观察组30d主要不良心血管事件发生率(9.7%)低于对照组(23.8%)(P<0.05),2组出血事件发生率比较差异无统计学意义(P>0.05)。结论 PCI术前静脉应用替罗非班联合高负荷剂量氯吡格雷,可改善ACS患者PCI术后心肌灌注、减少30d内主要心血管事件发生率,且不增加出血风险。
Objective To investigate the effect of high-dose clopidogrel combined with tirofiban on percutaneous coronary intervention (PCI) in patients with high-risk non-ST-segment elevation acute coronary syndrome (ACS) safety. Methods A total of 152 high-risk non-ST-segment elevation ACS patients undergoing PCI were enrolled in this study. Preoperative clopidogrel 600 mg + tirofiban 0.4 μg / (kg · min) was injected intravenously for 30 min followed by 0.1 μg / (kg · min ) Continuous intravenous injection of 36h after operation in 72 patients as observation group, preoperative only oral clopidogrel 600mg 80 patients as control group, TIMI flow classification after PCI, myocardial perfusion, major adverse cardiovascular events within 30d And the incidence of bleeding complications. Results The incidence of myocardial perfusion grade TMPG level 2 or above (87.5%) in PCI group was significantly higher than that in control group (72.5%) (P <0.05). The corrected TIMI frame rate in observation group was significantly lower than that in control group (24.70 ± 6.60) 27.33 ± 6.42) (P <0.05). There was no significant difference in the incidence of TIMI 3 grade between the two groups (P> 0.05). The incidence of major adverse cardiovascular events (9.7%) in the observation group at 30 days (23.8%) (P <0.05). There was no significant difference in the incidence of bleeding between the two groups (P> 0.05). Conclusion Preoperative intravenous infusion of tirofiban combined with high-loading dose of clopidogrel before PCI can improve myocardial perfusion in ACS patients after PCI and reduce the incidence of major cardiovascular events within 30 days without increasing the risk of bleeding.