中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2010年
11期
927-931
,共5页
王晖%宋梅%薛朝阳%杨志健%朱铁兵%王连生%陆民%张宁%李伟%曹克将
王暉%宋梅%薛朝暘%楊誌健%硃鐵兵%王連生%陸民%張寧%李偉%曹剋將
왕휘%송매%설조양%양지건%주철병%왕련생%륙민%장저%리위%조극장
心绞痛,不稳定型%心肌梗死%心肌再灌注
心絞痛,不穩定型%心肌梗死%心肌再灌註
심교통,불은정형%심기경사%심기재관주
Angina,unstable%Myocardial infarction%Myocardial reperfusion
目的 探讨早期介入治疗的老年高危急性冠状动脉综合征(ACS)患者应用替罗非班的疗效分析. 方法 选择接受早期冠状动脉介入治疗(PCI)的老年不稳定型心绞痛和(或)非ST段抬高心肌梗死(UA/NSTEMI)患者162例,按替罗非班使用时间分常规早期治疗组(82例)和延期选择性治疗组(80例),分别评估两种治疗方案对PCI术前、术后即刻冠状动脉血流、心肌组织水平灌注和30 d复合心血管事件等观察指标的影响. 结果 PCI术前心肌梗死溶栓试验(TIMI)血流心肌灌注分级(TMPG)0～1级共65例(40.1%),其中早期治疗组27例(32.9%),延期治疗组38例(47.5%),早期治疗组PCI术前TMPG分级0～1级发生率低于延期治疗组(x2=3.58,P＜0.05);两组PCI术前TIMI 0～1级血流[22例(26.8%)和20例(25.0%)]、术后即刻TIMI 3级血流[80例(97.6%)和77例(96.3%)]及术前、术后校正的TIMI血流计帧数分别为(34.2±11.8)帧和(34.9±12.7)帧、(23.1±4.6)帧和(22.6±3.8)帧,差异无统计学意义(x2值分别为0.07、0.23、0.49;t值分别为0.13、0.57,均P＞0.05);30 d复合心血管事件及出血发生率两组差异无统计学意义(x2值分别为0.31、0.004,均P＞0.05). 结论 替罗非班早期治疗老年高危ACS患者能改善PCI术前心肌微循环,提高组织水平灌注.
目的 探討早期介入治療的老年高危急性冠狀動脈綜閤徵(ACS)患者應用替囉非班的療效分析. 方法 選擇接受早期冠狀動脈介入治療(PCI)的老年不穩定型心絞痛和(或)非ST段抬高心肌梗死(UA/NSTEMI)患者162例,按替囉非班使用時間分常規早期治療組(82例)和延期選擇性治療組(80例),分彆評估兩種治療方案對PCI術前、術後即刻冠狀動脈血流、心肌組織水平灌註和30 d複閤心血管事件等觀察指標的影響. 結果 PCI術前心肌梗死溶栓試驗(TIMI)血流心肌灌註分級(TMPG)0～1級共65例(40.1%),其中早期治療組27例(32.9%),延期治療組38例(47.5%),早期治療組PCI術前TMPG分級0～1級髮生率低于延期治療組(x2=3.58,P＜0.05);兩組PCI術前TIMI 0～1級血流[22例(26.8%)和20例(25.0%)]、術後即刻TIMI 3級血流[80例(97.6%)和77例(96.3%)]及術前、術後校正的TIMI血流計幀數分彆為(34.2±11.8)幀和(34.9±12.7)幀、(23.1±4.6)幀和(22.6±3.8)幀,差異無統計學意義(x2值分彆為0.07、0.23、0.49;t值分彆為0.13、0.57,均P＞0.05);30 d複閤心血管事件及齣血髮生率兩組差異無統計學意義(x2值分彆為0.31、0.004,均P＞0.05). 結論 替囉非班早期治療老年高危ACS患者能改善PCI術前心肌微循環,提高組織水平灌註.
목적 탐토조기개입치료적노년고위급성관상동맥종합정(ACS)환자응용체라비반적료효분석. 방법 선택접수조기관상동맥개입치료(PCI)적노년불은정형심교통화(혹)비ST단태고심기경사(UA/NSTEMI)환자162례,안체라비반사용시간분상규조기치료조(82례)화연기선택성치료조(80례),분별평고량충치료방안대PCI술전、술후즉각관상동맥혈류、심기조직수평관주화30 d복합심혈관사건등관찰지표적영향. 결과 PCI술전심기경사용전시험(TIMI)혈류심기관주분급(TMPG)0～1급공65례(40.1%),기중조기치료조27례(32.9%),연기치료조38례(47.5%),조기치료조PCI술전TMPG분급0～1급발생솔저우연기치료조(x2=3.58,P＜0.05);량조PCI술전TIMI 0～1급혈류[22례(26.8%)화20례(25.0%)]、술후즉각TIMI 3급혈류[80례(97.6%)화77례(96.3%)]급술전、술후교정적TIMI혈류계정수분별위(34.2±11.8)정화(34.9±12.7)정、(23.1±4.6)정화(22.6±3.8)정,차이무통계학의의(x2치분별위0.07、0.23、0.49;t치분별위0.13、0.57,균P＞0.05);30 d복합심혈관사건급출혈발생솔량조차이무통계학의의(x2치분별위0.31、0.004,균P＞0.05). 결론 체라비반조기치료노년고위ACS환자능개선PCI술전심기미순배,제고조직수평관주.
Objective To explore the curative effect of tirofiban treatment on high-risk acute coronary syndromes (ACS) in elderly patients receiving an early percutaneous coronary intervention (PCI) treatment. Methods The 162 elderly cases including unstable angina pectoris and non-ST -segment elevation myocardial infarction (NSTEMI) undergoing early PCI were enrolled in this study.And they were assigned to early treatment group (n=82) and deferred selective group (n=80)according to the time of using tirofiban (Gp Ⅱ b/Ⅲ a inhibitor) treatment. The effectiveness of either strategic option on tissue-level perfusion was evaluated using the TIMI myocardial perfusion grade (TMPG) before and immediately after PCI. The corrected TIMI frame count (cTFC) was also used to assess coronary artery flow and myocardial perfusion. Bleeding complications and the composite end point events at 30 days were also evaluated. Results Of all the 162 patients, the TMPG 0-1 perfusion was observed in 65 patients (40.1%). The TMPG 0-1 perfusion was significantly less frequent in early treatment group (32.9%) than in deferred selective group (47.5%) before PCI (x2=3.58, P＜0.05); while the results of TIMI grade 0-1 flow (26.8% vs. 25.0%) and cTFC levels (34.2±11.8 vs. 34. 9±12. 7) before PCI were similar between the two groups (x2 =0. 07, P=0.47; t= 0.13, P=0.71, respectively). No differences were seen both in composite end point events at 30 days and bleeding complications (x2 = 0.31, P＞0.05; x2=0.004, P＞0. 05). Conclusions High -risk ACS patients treated with an early invasive strategy, routine upstream use of tirofiban are associated with improved tissue-level perfusion before PCI and does not increase bleeding complications when bleeding risks are carefully evaluated before enrollment.
