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目的:探讨急性心肌梗死(AMI)急诊冠状动脉介入治疗(PCI)、复杂冠状动脉病变PCI术后应用盐酸替罗非班替代术后肝素化的临床疗效及安全性。方法:选AMI、冠状动脉造影示复杂病变及伴发糖尿病行PCI者共64例,分为术后肝素化组(34例)和盐酸替罗非班组(30例),分别给予术后肝素化(肝素600～800U/h,持续18h)及盐酸替罗非班(术后即刻静脉注射盐酸替罗非班10μg·kg-1,继以0.15μg·kg-1·min-1持续静脉泵入,维持36h后停用),使用替罗非班期间低分子肝素钙用量减半。结果:住院期间及出院后随访1个月,2组患者均无支架内急性或亚急性血栓形成、无新近心肌梗死及再次急诊PCI,盐酸替罗非班组严重出血并发症明显低于肝素组。结论:盐酸替罗非班用于AMI急诊PCI、复杂冠状动脉病变PCI后预防急性及亚急性血栓形成的疗效与术后肝素化接近,严重出血并发症低于肝素组。
Objective: To investigate the clinical efficacy and safety of tirofiban instead of postoperative heparin in patients with acute myocardial infarction (AMI) undergoing emergency coronary intervention (PCI) and complicated coronary artery disease after PCI. Methods: A total of 64 patients with complicated lesions and coronary artery disease accompanied with diabetes undergoing AMI and coronary angiography were divided into postoperative heparinized group (n = 34) and tirofiban hydrochloride group (n = 30). Postoperative heparinization (Heparin 600 ~ 800U / h for 18h) and tirofiban hydrochloride (immediate intravenous injection of tirofiban 10μg · kg-1, followed by 0.15μg · kg-1 · min-1 continuous intravenous infusion , To maintain 36h after the disabled), the use of low molecular weight heparin calcium dosage of tirofiban halved. Results: There was no acute or subacute thrombosis during the hospitalization and 1 month after discharge. There were no new myocardial infarction and emergency PCI. The complications of severe bleeding in tirofiban hydrochloride group were significantly lower than those in heparin group. Conclusion: Tirofiban Hydrochloride is used in acute PCI of AMI. The efficacy of PCI in prevention of acute and subacute thrombosis after PCI is similar to that of heparinization after PCI. The complication of severe bleeding is lower than that of heparin group.