中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2012年
2期
131-135
,共5页
任晓楠%王乐丰%王明生%徐立
任曉楠%王樂豐%王明生%徐立
임효남%왕악봉%왕명생%서립
心肌梗死%血小板聚集抑制剂%血管成形术,经腔,经皮冠状动脉
心肌梗死%血小闆聚集抑製劑%血管成形術,經腔,經皮冠狀動脈
심기경사%혈소판취집억제제%혈관성형술,경강,경피관상동맥
Myocardial infarction%Platelet aggregation inhibitors%Angioplasty,transluminal,percutaneous coronary
目的 探讨早期应用大剂量替罗非班对急性ST段抬高型心肌梗死(STEMI)患者急诊介入术后血小板聚集功能及活性的影响.方法 入选120例急性STEMI拟行急诊介入治疗的患者,在给予负荷剂量的阿司匹林(300 mg)和氯吡格雷(600 mg)后,于冠状动脉造影前随机分为大剂量组(替罗非班25 μg/kg静脉推注,继之以0.15 μg·kg-1·min-1静脉维持泵入36 h,共40例)、常规剂量组(替罗非班10 μg/kg静脉推注,继之以0.15 μg·kg-1·min-1静脉维持泵人36 h,共40例)和对照组(不应用替罗非班,共40例).分别于入选后即刻、替罗非班应用后10 min和24 h、停用替罗非班后12和24 h抽血,采用血栓弹力图测定血小板聚集功能的抑制率(IPA)及活性.结果 3组之间的入选后即刻IPA差异无统计学意义(P＞0.05).替罗非班应用后10 min,大剂量组的IPA显著高于常规剂量组和对照组[(84.2±12.0)％比(67.8±26.8)％和(31.5±21.9)％,P均＜0.01].替罗非班应用后24 h,大剂量组及常规剂量组对血小板聚集的抑制水平达到高峰,IPA分别为(93.0±9.8)％和(88.5±18.1)％,两组之间差异无统计学意义(P＞0.05),且均显著高于对照组[(40.4±22.8)％,P均＜0.01].停用替罗非班后12和24 h,3组之间的IPA差异无统计学意义(P均＞0.05).大剂量组与常规剂量组之间不同时间的血小板活性差异均无统计学意义(P均＞0.05).替罗非班应用10 min和24 h后,大剂量组和常规剂量组的血小板活性均低于对照组[分别为(47.2±7.6)mm和(50.0 ±9.8)mm比(57.7±6.5) mm,P均＜0.01；(54.6±5.6) mm和(54.3 ±9.0) mm比(59.6 ±4.0)mm,P均＜0.01].结论 对于急性STEMI行急诊介入治疗的患者,早期应用大剂量替罗非班可能较常规剂量能更好地抑制血小板聚集和活性.
目的 探討早期應用大劑量替囉非班對急性ST段抬高型心肌梗死(STEMI)患者急診介入術後血小闆聚集功能及活性的影響.方法 入選120例急性STEMI擬行急診介入治療的患者,在給予負荷劑量的阿司匹林(300 mg)和氯吡格雷(600 mg)後,于冠狀動脈造影前隨機分為大劑量組(替囉非班25 μg/kg靜脈推註,繼之以0.15 μg·kg-1·min-1靜脈維持泵入36 h,共40例)、常規劑量組(替囉非班10 μg/kg靜脈推註,繼之以0.15 μg·kg-1·min-1靜脈維持泵人36 h,共40例)和對照組(不應用替囉非班,共40例).分彆于入選後即刻、替囉非班應用後10 min和24 h、停用替囉非班後12和24 h抽血,採用血栓彈力圖測定血小闆聚集功能的抑製率(IPA)及活性.結果 3組之間的入選後即刻IPA差異無統計學意義(P＞0.05).替囉非班應用後10 min,大劑量組的IPA顯著高于常規劑量組和對照組[(84.2±12.0)％比(67.8±26.8)％和(31.5±21.9)％,P均＜0.01].替囉非班應用後24 h,大劑量組及常規劑量組對血小闆聚集的抑製水平達到高峰,IPA分彆為(93.0±9.8)％和(88.5±18.1)％,兩組之間差異無統計學意義(P＞0.05),且均顯著高于對照組[(40.4±22.8)％,P均＜0.01].停用替囉非班後12和24 h,3組之間的IPA差異無統計學意義(P均＞0.05).大劑量組與常規劑量組之間不同時間的血小闆活性差異均無統計學意義(P均＞0.05).替囉非班應用10 min和24 h後,大劑量組和常規劑量組的血小闆活性均低于對照組[分彆為(47.2±7.6)mm和(50.0 ±9.8)mm比(57.7±6.5) mm,P均＜0.01；(54.6±5.6) mm和(54.3 ±9.0) mm比(59.6 ±4.0)mm,P均＜0.01].結論 對于急性STEMI行急診介入治療的患者,早期應用大劑量替囉非班可能較常規劑量能更好地抑製血小闆聚集和活性.
목적 탐토조기응용대제량체라비반대급성ST단태고형심기경사(STEMI)환자급진개입술후혈소판취집공능급활성적영향.방법 입선120례급성STEMI의행급진개입치료적환자,재급여부하제량적아사필림(300 mg)화록필격뢰(600 mg)후,우관상동맥조영전수궤분위대제량조(체라비반25 μg/kg정맥추주,계지이0.15 μg·kg-1·min-1정맥유지빙입36 h,공40례)、상규제량조(체라비반10 μg/kg정맥추주,계지이0.15 μg·kg-1·min-1정맥유지빙인36 h,공40례)화대조조(불응용체라비반,공40례).분별우입선후즉각、체라비반응용후10 min화24 h、정용체라비반후12화24 h추혈,채용혈전탄력도측정혈소판취집공능적억제솔(IPA)급활성.결과 3조지간적입선후즉각IPA차이무통계학의의(P＞0.05).체라비반응용후10 min,대제량조적IPA현저고우상규제량조화대조조[(84.2±12.0)％비(67.8±26.8)％화(31.5±21.9)％,P균＜0.01].체라비반응용후24 h,대제량조급상규제량조대혈소판취집적억제수평체도고봉,IPA분별위(93.0±9.8)％화(88.5±18.1)％,량조지간차이무통계학의의(P＞0.05),차균현저고우대조조[(40.4±22.8)％,P균＜0.01].정용체라비반후12화24 h,3조지간적IPA차이무통계학의의(P균＞0.05).대제량조여상규제량조지간불동시간적혈소판활성차이균무통계학의의(P균＞0.05).체라비반응용10 min화24 h후,대제량조화상규제량조적혈소판활성균저우대조조[분별위(47.2±7.6)mm화(50.0 ±9.8)mm비(57.7±6.5) mm,P균＜0.01；(54.6±5.6) mm화(54.3 ±9.0) mm비(59.6 ±4.0)mm,P균＜0.01].결론 대우급성STEMI행급진개입치료적환자,조기응용대제량체라비반가능교상규제량능경호지억제혈소판취집화활성.
Objective To investigate the effect of early high-loading-dose tirofiban on platelet activity for patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention.Methods A total of 120 acute STEMI patients were treated with 300 mg aspirin and 600 mg loading dose clopidogrel and randomized to high-dose tirofiban (25 μg/kg bolus followed by0.15 μg · kg-1 · min-1 infusion for 36 hours,n =40),standard-dose tirofiban (10 μg/kg bolus followed by 0.15 μg · kg-1 · min-1 infusion for 36 hours,n =40) or control (no tirofiban,n =40) before angiography.Inhibition of platelet aggregation (IPA) was assessed before angiography,at 10 min and 24 hours after tirofiban infusion, and at 12 and 24 hours after stopping tirofiban infusion by the thrombelastography assay.Results There was no significant difference in baseline of IPA between the 3 groups (P ＞ 0.05 ).IPA was significantly higher in high-dose tirofiban group compared with standard-dose tirofiban and no tirofiban group at 10 minutes after tirofiban infusion [ ( 84.2 ± 12.0 ) ％ vs.( 67.8 ±26.8 ) ％ and (31.5 ± 21.9) ％,all P ＜ 0.01 ].At 24 hours after tirofiban infusion,the IPA of high-dose and standard-dose tirofiban was similar [ ( 93.0 ± 9.8 ) ％ vs. ( 88.5 ± 18.1 ) ％,P ＞ 0.05 ] and was significantly higher than no tirofiban group [ (40.4 ± 22.8 ) ％,all P ＜ 0.01 ].IPA was similar at 12 and 24 hours after stopping tirofiban use among the 3 groups( all P ＞ 0.05 ).The maximum amplitude of high-dose tirofiban and standard-dose tirofiban groups at different time points was similar( all P ＞ 0.05),and maximum amplitude in both tirofiban groups was significantly lower than in no tirofiban group at 10 min [ (47.2 ± 7.6)mm and (50.0 ± 9.8 ) mm vs.(57.7 ± 6.5 ) mm,all P ＜ 0.01 ] and at 24 hours after stopping tirofiban infusion [ (54.6 ± 5.6 )mm and ( 54.3 ± 9.0) mm vs.(59.6 ± 4.0) mm,all P ＜ 0.01 ].Conclusion Early use of high-loading-dose of tirofiban on top of 600 mg loading dose clopidogrel is more efficient on inhibiting platelet activity than standard dose of tirofiban in patients with acute STEMI undergoing primary primary percutaneous coronary intervention.
