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目的探讨替罗非班对直接经皮冠状动脉介入治疗(PCI)患者心肌灌注及疗效的影响。方法收集我院2005年6月至2006年4月因急性心肌梗死(AMI)住院的患者105例,分为甲组(54例,予直接PCI+替罗非班)和乙组(51例,仅予直接PCI)。比较两组直接PCI后心肌微循环灌注、心功能和心脏事件发生率。结果甲组术后TIMI血流3级、TMP血流3级的例数分别为49例(91％)和43例(80％),乙组分别为47例(92%)和39例(76％);两组间的差异均无统计学意义(P值均>0．05)。两组术后1h及3 d心电图梗死相关导联ST段回落>50％的例数和术后1周靶血管急诊PCI后病变处心肌显像良好例数的差异均有统计学意义(P值均< 0．05)。两组住院期间和随访期间各项心脏事件发生率分别为0．2％(1例)和17．6%9例,差异有统计学意义(P<0．05)。住院期间,甲、乙两组左室射血分数(LVEF)分别为(54±6)％和(53±3)％,左室收缩期末直径(ES)分别为(32±7)mm和(34±3)mm,左室舒张期末直径(ED)分别为(51±6)mm和(52±4)mm,差异均无统计学意义(P值均>0．05)。随访期间,两组LVEF分别为(58±6)％和(53±2)%,ES分别为(31±8)mm和(36±6)mm,ED分别为(52±1)mm和(55±2)mm,差异均有统计学意义(P值均<0．05)。结论晚期静脉应用替罗非班对改善直接PCI患者心肌灌注是安全、有效的,能显著减少心脏事件的发生及改善心功能。
Objective To investigate the effect of tirofiban on myocardial perfusion and efficacy in patients undergoing direct percutaneous coronary intervention (PCI). Methods A total of 105 hospitalized patients with acute myocardial infarction (AMI) from June 2005 to April 2006 in our hospital were divided into two groups: group A (54 cases, direct PCI plus tirofiban) and group B (51 cases, only To direct PCI). The perfusion of myocardial microcirculation, cardiac function and incidence of cardiac events were compared between two groups after PCI. Results In group A, there were 49 cases (91%) and 43 cases (80%) with TIMI grade 3 and TMP grade 3 respectively, 47 cases (92%) and 39 cases %). There was no significant difference between the two groups (P> 0.05). There were significant differences between the two groups in the number of ST segment depression> 50% at 1 h and 3 d after PCI and the number of myocardial imaging at the time point after PCI in the target group at 1 week after PCI All <0.05). The incidence of cardiac events during hospitalization and follow-up were 0.2% (1 case) and 17.6% (9 cases), respectively, with significant difference (P <0.05). During hospitalization, left ventricular ejection fraction (LVEF) in group A and group B were (54 ± 6)% and (53 ± 3)%, respectively. The mean systolic left ventricular (ESV) were (32 ± 7) mm and 34 ± 3) mm, and the mean left ventricular end diastolic diameter (ED) were (51 ± 6) mm and (52 ± 4) mm, respectively, with no significant difference (all P values> 0.05). During follow-up, the LVEFs in the two groups were (58 ± 6)% and (53 ± 2)%, respectively, with ES values of (31 ± 8) mm and (36 ± 6) mm and ED of 52 ± 1 and 55 ± 2) mm, the differences were statistically significant (P <0.05). Conclusion The late intravenous application of tirofiban can improve myocardial perfusion in patients with direct PCI is safe and effective, can significantly reduce the incidence of cardiac events and improve cardiac function.