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目的:探讨急性冠状动脉综合征(ACS)患者择期经皮冠状动脉支架置入术前、术中、术后应用国产盐酸替罗非班的疗效和安全性。方法:ACS患者280例,随机分为替罗非班组和对照组,其中替罗非班组分为术前组(68例)、术中组(70例)、术后组(72例)。用比浊法测定ADP诱导的血小板聚集率,观察4组术后30d内主要不良心血管事件(MACE)的发生率;出血并发症及拔管后压迫止血15min后出血率;术后3d血小板计数。结果:与对照组比较,替罗非班组30d内MACE(包括顽固性心绞痛、新发心肌梗死、心源性死亡、再次血运重建)发生率显著降低,血小板聚集率明显降低(P<0.05)。拔管后压迫止血15min后出血率术前、术中组较术后、对照组明显增高(P<0.05)。替罗非班组间血小板聚集率差异无统计学意义(P>0.05)。4组出血并发症、术后血小板计数差异无统计学意义(P>0.05)。结论:替罗非班术后应用也能降低血小板聚集率和术后MACE发生率,拔管后压迫止血15min后出血率下降。
Objective: To investigate the efficacy and safety of domestic tirofiban hydrochloride before, during and after the percutaneous coronary stent implantation in patients with acute coronary syndrome (ACS). Methods: A total of 280 patients with ACS were randomly divided into Tirofiban group and control group. Tirofiban group was divided into preoperative group (68 cases), intraoperative group (70 cases) and postoperative group (72 cases). The rate of platelet aggregation induced by ADP was measured by turbidimetry. The incidence of major adverse cardiovascular events (MACE) within 30 days after operation was observed in 4 groups. The bleeding complication and hemorrhage rate after 15 min of extubation were compared. The platelet count . Results: Compared with the control group, the incidence of MACE (including refractory angina pectoris, myocardial infarction, cardiogenic death and revascularization) in the tirofiban group was significantly decreased and the platelet aggregation rate was significantly decreased (P <0.05) . After extubation hemostasis 15min after bleeding, preoperative, intraoperative and postoperative group, the control group was significantly higher (P <0.05). Tirofiban group platelet aggregation rate difference was not statistically significant (P> 0.05). There was no significant difference in bleeding complication and postoperative platelet count between the four groups (P> 0.05). Conclusion: Tirofiban can reduce the rate of platelet aggregation and the incidence of postoperative MACE postoperatively. After extubation, hemorrhage rate decreased after 15min of hemostasis.