CAJ | 학술논문

目的分析老年急性冠状动脉(冠脉)综合征(ACS)患者替罗非班不同负荷和不同用药途径对心肌灌注和30 d主要不良心血管事件(MACE)的影响,探讨替罗非班的负荷用药最佳途径.方法 2009年7月至2010年7月,连续入选120例老年ACS患者,均行经皮冠状动脉介入术(PCI),术前开始用替罗非班.根据负荷给药途径不同分为两组:冠脉内用药组和静脉用药组,各60例.观察两组患者PCI后冠脉血流、心肌灌注及PCI术后30 d的MACE.结果冠脉内用药组病变冠脉的急性心肌梗死溶栓试验(TIMI)血流分级3级、TIMI心肌灌注分级(TMPG)3级率明显高于静脉用药组[分别为53例(88.3%)、38例(63.3%)和40例(66.7%)],两两比较,均P＜0.05,但两组患者院内和PCI后30 d的MACE[分别为1(1.7%)和0,3(5.0%)和5(8.3%)]及不同程度出血和血小板减少症发生率比较差异均无统计学意义.结论老年ACS患者PCI前冠脉内使用负荷剂量替罗非班与静脉内用药途径比较,能更有效地增加冠状动脉血流及心肌水平的灌注.
목적 분석노년급성관상동맥(관맥)종합정(ACS)환자체라비반불동부하화불동용약도경대심기관주화30 d주요불양심혈관사건(MACE)적영향,탐토체라비반적부하용약최가도경.방법 2009년7월지2010년7월,련속입선120례노년ACS환자,균행경피관상동맥개입술(PCI),술전개시용체라비반.근거부하급약도경불동분위량조:관맥내용약조화정맥용약조,각60례.관찰량조환자PCI후관맥혈류、심기관주급PCI술후30 d적MACE.결과 관맥내용약조병변관맥적급성심기경사용전시험(TIMI)혈류분급3급、TIMI심기관주분급(TMPG)3급솔명현고우정맥용약조[분별위53례(88.3%)、38례(63.3%)화40례(66.7%)],량량비교,균P＜0.05,단량조환자원내화PCI후30 d적MACE[분별위1(1.7%)화0,3(5.0%)화5(8.3%)]급불동정도출혈화혈소판감소증발생솔비교차이균무통계학의의.결론 노년ACS환자PCI전관맥내사용부하제량체라비반여정맥내용약도경비교,능경유효지증가관상동맥혈류급심기수평적관주.
Objective To analyze the therapeutic effect of intracoronary versus intravenous bolus tirofiban on myocardial perfusion and major cardiovascular events (MACE) in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and explore the optimal route of tirofiban application. Methods From July 2009 to July 2010, 120 NSTE-ACS patients undergoing percutaneous coronary intervention (PCI ) were consecutively enrolled in this study. They were randomly divided into two groups: intracoronary (60 cases) versus intravenous (60 cases) bolus tirofiban. Thrombolysis in myocardial infarction (TIMI) flow, TIMI myocardial perfusion grade (TMPG) and MACE 30 days after PCI were observed. Results The incidence of TIMI flow and TMPG 3 grade in intracoronary group were higher than in intravenous group [53(88.3%) vs. 38(63.3%); 53(88.3%) vs. 40(66.7%), respectively, both P＜0.05]. However, MACE incidence and bleeding complications during hospital 30 days after PCI had no significant difference between the two groups [1 (1.7%) vs. 0; 3(5.0%) vs. 5(8.3%)], which were not statistically significant (P＞0.05). Conclusions Intracoronary bolus tirofiban before PCI more effectively increases coronary blood flow and myocardium blush than intravenous route in elderly NSTE-ACS patients.