中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
24期
3-6
,共4页
陈立伟%杨明%高亢%孙一光%韩凌
陳立偉%楊明%高亢%孫一光%韓凌
진립위%양명%고항%손일광%한릉
心肌梗死%冠状血管%替罗非班
心肌梗死%冠狀血管%替囉非班
심기경사%관상혈관%체라비반
Myocardial infarction%Coronary vessels%Tirofiban
目的 评价不同时机应用盐酸替罗非班在急性ST段抬高性心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)中的有效性和安全性。方法 将158例急性STEMI患者按入院顺序随机分为替罗非班治疗组1（确诊后立即静脉滴注盐酸替罗非班+ PCI，59例）、替罗非班治疗组2（冠状动脉内注射盐酸替罗非班+PCI，56例）和对照组（直接PCI，43例）。比较三组患者梗死相关动脉PCI术后即刻TIMI血流及远端栓塞情况，ST段抬高总和回落百分比（sum STR），PCI术后6、12h肌酸激酶同工酶(CK-MB)水平，术后1周左室射血分数(LVEF)，术后30d内严重心脏不良事件(MACE)发生率，出血发生率，术后血小板计数。结果 替罗非班治疗组1、替罗非班治疗组2 PCI术后即刻TIMI 3级血流发生率分别为98.3％( 58/59)和92.9％( 52/56)，均明显高于对照组的60.5％( 26/43)，差异有统计学意义(P＜0.05)；替罗非班治疗组1和替罗非班治疗组2 PCI术后90 min sum STR分别为(89.3±6.9)％和(82.4±7.3)％，与对照组的(65.6±8.1)％比较差异有统计学意义(P＜0.01)，且替罗非班治疗组1和替罗非班治疗组2比较差异也有统计学意义(P＜0.05)；替罗非班治疗组1和替罗非班治疗组2 PCI术后30 d内MACE发生率明显低于对照组(P＜0.05)；替罗非班治疗组1术后6、12 h CK-MB水平显著低于替罗非班治疗组2，替罗非班治疗组2低于对照组，差异均有统计学意义(P＜0.05)；替罗非班治疗组1术后1周LVEF[(56.2±6.4)％]显著高于替罗非班治疗组2[(51.1±4.9)％]和对照组[(49.8±5.7)％](P＜0.05)，但替罗非班治疗组2与对照组比较差异无统计学意义(P＞0.05)。替罗非班治疗组1、替罗非班治疗组2 PCI术后皮肤黏膜出血率显著高于对照组，但均未发生严重出血和血小板减少症。结论 术前早期应用盐酸替罗非班能明显降低STEMI患者PCI术后缺血事件的发生，在急诊PCI中是有效而安全的。
目的 評價不同時機應用鹽痠替囉非班在急性ST段抬高性心肌梗死(STEMI)患者急診經皮冠狀動脈介入(PCI)中的有效性和安全性。方法 將158例急性STEMI患者按入院順序隨機分為替囉非班治療組1（確診後立即靜脈滴註鹽痠替囉非班+ PCI，59例）、替囉非班治療組2（冠狀動脈內註射鹽痠替囉非班+PCI，56例）和對照組（直接PCI，43例）。比較三組患者梗死相關動脈PCI術後即刻TIMI血流及遠耑栓塞情況，ST段抬高總和迴落百分比（sum STR），PCI術後6、12h肌痠激酶同工酶(CK-MB)水平，術後1週左室射血分數(LVEF)，術後30d內嚴重心髒不良事件(MACE)髮生率，齣血髮生率，術後血小闆計數。結果 替囉非班治療組1、替囉非班治療組2 PCI術後即刻TIMI 3級血流髮生率分彆為98.3％( 58/59)和92.9％( 52/56)，均明顯高于對照組的60.5％( 26/43)，差異有統計學意義(P＜0.05)；替囉非班治療組1和替囉非班治療組2 PCI術後90 min sum STR分彆為(89.3±6.9)％和(82.4±7.3)％，與對照組的(65.6±8.1)％比較差異有統計學意義(P＜0.01)，且替囉非班治療組1和替囉非班治療組2比較差異也有統計學意義(P＜0.05)；替囉非班治療組1和替囉非班治療組2 PCI術後30 d內MACE髮生率明顯低于對照組(P＜0.05)；替囉非班治療組1術後6、12 h CK-MB水平顯著低于替囉非班治療組2，替囉非班治療組2低于對照組，差異均有統計學意義(P＜0.05)；替囉非班治療組1術後1週LVEF[(56.2±6.4)％]顯著高于替囉非班治療組2[(51.1±4.9)％]和對照組[(49.8±5.7)％](P＜0.05)，但替囉非班治療組2與對照組比較差異無統計學意義(P＞0.05)。替囉非班治療組1、替囉非班治療組2 PCI術後皮膚黏膜齣血率顯著高于對照組，但均未髮生嚴重齣血和血小闆減少癥。結論 術前早期應用鹽痠替囉非班能明顯降低STEMI患者PCI術後缺血事件的髮生，在急診PCI中是有效而安全的。
목적 평개불동시궤응용염산체라비반재급성ST단태고성심기경사(STEMI)환자급진경피관상동맥개입(PCI)중적유효성화안전성。방법 장158례급성STEMI환자안입원순서수궤분위체라비반치료조1（학진후립즉정맥적주염산체라비반+ PCI，59례）、체라비반치료조2（관상동맥내주사염산체라비반+PCI，56례）화대조조（직접PCI，43례）。비교삼조환자경사상관동맥PCI술후즉각TIMI혈류급원단전새정황，ST단태고총화회락백분비（sum STR），PCI술후6、12h기산격매동공매(CK-MB)수평，술후1주좌실사혈분수(LVEF)，술후30d내엄중심장불량사건(MACE)발생솔，출혈발생솔，술후혈소판계수。결과 체라비반치료조1、체라비반치료조2 PCI술후즉각TIMI 3급혈류발생솔분별위98.3％( 58/59)화92.9％( 52/56)，균명현고우대조조적60.5％( 26/43)，차이유통계학의의(P＜0.05)；체라비반치료조1화체라비반치료조2 PCI술후90 min sum STR분별위(89.3±6.9)％화(82.4±7.3)％，여대조조적(65.6±8.1)％비교차이유통계학의의(P＜0.01)，차체라비반치료조1화체라비반치료조2비교차이야유통계학의의(P＜0.05)；체라비반치료조1화체라비반치료조2 PCI술후30 d내MACE발생솔명현저우대조조(P＜0.05)；체라비반치료조1술후6、12 h CK-MB수평현저저우체라비반치료조2，체라비반치료조2저우대조조，차이균유통계학의의(P＜0.05)；체라비반치료조1술후1주LVEF[(56.2±6.4)％]현저고우체라비반치료조2[(51.1±4.9)％]화대조조[(49.8±5.7)％](P＜0.05)，단체라비반치료조2여대조조비교차이무통계학의의(P＞0.05)。체라비반치료조1、체라비반치료조2 PCI술후피부점막출혈솔현저고우대조조，단균미발생엄중출혈화혈소판감소증。결론 술전조기응용염산체라비반능명현강저STEMI환자PCI술후결혈사건적발생，재급진PCI중시유효이안전적。
Objective To evaluate the safety and efficacy of tirofiba in the treatment of patients with acute ST-elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). Methods A total of 158 patients with acute STEMI were randomly divided into tirofiban group 1 (59 cases, received tirofiban before PCI), tirofiban group 2 (56 cases, received tirofiban when PCI) and control group (43 cases, only received PCI). The coronary reperfusion flow (TIMI grade) of infarct related artery (IRA) after PCI, the resolution of the sum of ST segment elevation (sum STR) at 90 min after the procedure, the changes of myocardial enzyme at 6 h and 12 h afterwards, the left ventricular ejection fraction (LVEF) 1 week later, the major adverse cardiac events(MACE) within 30 d, bleeding and thrombocytopenia complications were analyzed and compared among the three groups. Results TIMI reperfusion grades in tirofiban group 1[98.3％(58/59 )]and tirofiban group 2[92.9％(52/56)]were higher than those in control group[60.5％(26/43)](P ＜0.05). The resolution of sum STR at 90 min after PCI in tirofiban group 1 [(89.3 ± 6.9)％]and tirofiban group 2[(82.4 + 7.3)％]was higher than that in control group[(65.6 +8.1 )％](P＜ 0.01 ),and there was significant difference between tirofiban group I and tirofiban group 2 (P＜0.05 ). The occurrence of MACE within 30 d was lower in tirofiban group 1 and tirofiban group 2 than that in control group (P＜ 0.05). The level of CK-MB at 6 h and 12 h afterwards was lower in tirofiban group 1 than that in tirofiban group 2,and tirofiban group 2 was lower than control group (P＜ 0.05). LVEF 1 week later in tirofiban group 1[(56.2 + 6.4)％]was higher than that in tirofiban group 2[(51.1 + 4.9)％]and control group[(49.8 + 5.7)％](P ＜ 0.05),but there was no significant difference between tirofiban group 2 and control group (P ＞ 0.05). Although bleeding incidence in tirofiban group 1 and tirofiban group 2 was higher than that in control group, no severe bleeding and thrombocytopenia was observed. Conclusion Tirofiban can safely and effectively reduce the incidence of the ischemic events in the patients with acute STEM1 during preoperative of emergency PCI.
