CAJ | 학술논문

目的探讨老年急性ST段抬高心肌梗死(ASTEMI)患者急诊介入治疗联合应用国产替罗非班临床疗效的有效性及安全性.方法 2008年5月至2010年5月发病12 h内接受急诊PCI术的老年ASTEMI患者106例,年龄65～88(68.5±9.6)岁,按就诊顺序分为替罗非班治疗组(n=54)和对照组(n=52),比较两组基础临床特征、心肌呈色分级(MBG)及术后90min心电图ST段回落百分比(sumSTR),并观察住院期间主要心血管事件、左室射血分数及出血并发症.结果两组基础临床情况和造影特征差异无统计学意义(P＞0.05).替罗非班组心肌呈色分级3级获得率明显增高(88.9%vs 57.7%,P＜0.05),术后90min心电图ST段把抬高回落＞50%者(70.3%vs42.3%,P＜0.05)显著高于对照组.替罗非班组心肌梗死后1周射血分数也明显高于对照组(56.2±7.6 vs 46.7±8.5,P＜0.05).两组住院期间主要心血管事件发生率比较差异无统计学意义(P＞0.05).替罗非班组轻度出血发生率有高于对照组趋势(11.1%vs 6.0%,P＞0.05),但无严重出血或血小板减少症.结论国产替罗非班能改善急诊PCI术后心肌灌注指标,并有助于改善心功能.老年ASTEMI患者急诊PCI联合使用替罗非班治疗是安全有效的.
목적 탐토노년급성ST단태고심기경사(ASTEMI)환자급진개입치료연합응용국산체라비반림상료효적유효성급안전성.방법 2008년5월지2010년5월발병12 h내접수급진PCI술적노년ASTEMI환자106례,년령65～88(68.5±9.6)세,안취진순서분위체라비반치료조(n=54)화대조조(n=52),비교량조기출림상특정、심기정색분급(MBG)급술후90min심전도ST단회락백분비(sumSTR),병관찰주원기간주요심혈관사건、좌실사혈분수급출혈병발증.결과 량조기출림상정황화조영특정차이무통계학의의(P＞0.05).체라비반조심기정색분급3급획득솔명현증고(88.9%vs 57.7%,P＜0.05),술후90min심전도ST단파태고회락＞50%자(70.3%vs42.3%,P＜0.05)현저고우대조조.체라비반조심기경사후1주사혈분수야명현고우대조조(56.2±7.6 vs 46.7±8.5,P＜0.05).량조주원기간주요심혈관사건발생솔비교차이무통계학의의(P＞0.05).체라비반조경도출혈발생솔유고우대조조추세(11.1%vs 6.0%,P＞0.05),단무엄중출혈혹혈소판감소증.결론 국산체라비반능개선급진PCI술후심기관주지표,병유조우개선심공능.노년ASTEMI환자급진PCI연합사용체라비반치료시안전유효적.
Objective To analyze the efficacy and safety of tirofiban treatment combined with percutaneous coronary intervention (PCI) in the elderly with acute ST segment elevation myocardial infarction prospectively. Methods From May 2008 to May 2010, 106 patients who presented with acute STEMI within 12 hours from onset and received successful primary PCI were enrolled into the study. All patients had angiographic evidence of initial total occlusion of infarct-related artery and finally restored toTIMI3 flow after PCI. All patients were divided into tirofiban group (n = 54) and control group (n = 52) according to whether tirofiban was used or not. Assessment of myocardial perfusion included Myocardial Blush Grades (MBG), and the resolution of the sum of ST-segment elevation (sumSTR) at 90 minutes after the procedure. Left ventricular ejection fraction (EF) was measured one week later. Major adverse cardiac events in hospital and bleeding complications were also assessed. Results Baseline clinical and angiographic characteristics of the two groups were similar. Significant higher rates of MBG 3 were observed in the tirofiban group (88. 9% vs57. 7%, P ＜ 0.05). Patients received tirofiban were more likely to achieve higher sumSTR (70. 3% vs 42. 3%, P ＜0. 05). Ejection fraction was also markedly increased in tirofiban group than control group (56. 2 ± 7.6 vs 46. 7 ± 8. 5, P ＜ 0. 05). In-hospital major adverse cardiac events, it was not different between the two groups(P ＞0. 05). There were slightly more minor bleeding complications in tirofiban group compared with control(11.1% vs 6. 0%, P ＞0. 05). No patient had major bleeding or thrombocytopenia.Conclusions Tirofiban can further ameliorate microvascular perfusion and it is safe and feasible for patients with STEMI undergoing primary PCI.