摘要
目的探讨替罗非班对急性心肌梗死（AMI）患者经皮冠状动脉介入治疗（PCI）后心肌灌注和血小板活化功能的影响。方法80例AMI患者按随机数字表法分为2组，均于发病12h内行急诊PCI术。对照组40例采用常规抗凝治疗（阿司匹林＋低分子肝素＋氯吡格雷）。替罗非班组40例在对照组治疗的基础上于PCI术中冠状动脉内注入盐酸替罗非班10μg/kg，静脉维持量0．15μg／（kg·min）36h。观察2组PCI术后15min梗死相关血管心肌灌注分级（TMPG）、治疗前及治疗7d后血小板活化功能的变化、术后30d内出血并发症及主要不良心脏事件（MACE）的发生情况。结果替罗非班组PCI术后15min TMPG灌注3级的百分比显著高于对照组[97．5％（39／40）与80．0％（32／40），x^2=4．507，P〈0．05]；治疗7d后，替罗非班组的血小板活化指标血小板α颗粒表面膜糖蛋白、溶酶体膜糖蛋白、单核细胞血小板聚集体的阳性表达率显著低于治疗前和对照组[替罗非班组治疗后：（1．7±0．7）％、（1．5±0．7）％、（11．7±3．8）％，治疗前：（7．2±2．5）％、（6．9±1．8）％、（22．0±7．8）％，t值分别为13．398、17．683、7．508；对照组治疗后：（2．9±1．2）％、（3．9±0．6）％、（16．2±4．2）％，t值分别为5．463、16．468、5．025，P均〈0．01]；治疗30d后，替罗非班组心血管事件发生率显著低于对照组（0％与15．0％（12／40），x^2=4．504，P〈0．05）；2组出血并发症发生率比较差异无统计学意义（10．0％（4／40）与5．0％（2／40），）（x^2=0．180，P〉0．05）。结论在AMI介入治疗中，应用盐酸替罗非班能改善心肌灌注，进一步抑制血小板的活化功能，减少PCI术后主要不良心脏事件的发生率，且不增加严重出血的发生。
Objective To evaluate the influence of tirofiban on myocardial perfusion through percutaneous coronary intervention （PCI） and platelet activation in patients with acute myocardial infarction （AMI）. Methods Eighty patients with acute myocardial infarction who underwent emergency PCI within 12 hours were randomly divided into 2 groups due to the random number table method： tirofiban group （40 patients） and control group （40 patients）. The control group received conventional anticoagulant therapy （aspirin 4- low molecular weight heparin ＋ clopidogrel）. The tirofiban group additionally received intracoronary tirofiban hydrochloride injection of 10 μg/kg PCI during PCI, intravenous maintenance dose of 0. 15 μg/（ kg · min） 36 h. To observe the infarct related artery myocardial perfusion grade （TMPG） of the 2 groups after PCI 15 mins, the changes of platelet activation before and after treatment 7 days, the bleeding complications and major adverse cardiac events （MACE） within 30 days after PCI. Results The TMPG 3 perfusion percentage of tirofiban group （97.5 %, 39/40） after PCI 15 minutes was significantly higher than that （80. 0%, 32/40） of the control group（ X^2 = 4. 507 ,P 〈 0. 05 ） ;The expression positive rate of platelet activation CD62P, CD63, MPA of the tirofiban group after treatment of 7 days were （ 1.7 ± 0.7 ） %, （ 1.5 ± 0. 7 ） % and （ 11.7 ±3.8 ） %, respectively, which were significantly lower than those of before treatment （ [ 7.2 ± 2. 5 ] %, [ 6. 9 ± 1.8 ] % and [ 22. 0 ± 7. 8 ] %, respectivley） and those of the control group after treatment of 7 days （ [ 2. 9 ± 1.21%,[3.9 ±0.6]% and [16. 2 ±4. 2]% ,respectivley） （t =5.463,16.468 and 5.025, Ps 〈0.01） ;The incidence of cardiovascular events of the tirofiban group （0） was significantly lower than that of the control group （ 15.0%, 12/40）after treatment of 30 days（ X^2 = 4. 504, P 〈 0. 05 ） ;The incidence of bleeding complications was not significant between the 2 groups （ X^2 = 0. 180, P 〉 0. 05 ）. Conclusion The application of tirofiban hydrochloride in intervention in acute myocardial infarction can improve myocardial perfusioo, and further inhibiting platelet activation and reduce the incidence of major adverse cardiac events after PCI while does not increase the incidence of severe bleeding.
出处
《中国综合临床》
2011年第3期245-248,共4页
Clinical Medicine of China
关键词
替罗非班
急性心肌梗死
经皮冠状动脉介入治疗
心肌灌注
血小板活化
Tirofiban
Acute myocardial infarction
Percutaneous coronary intervention
Myocardial perfusion
Platelet activation
