中国介入心脏病学杂志
中國介入心髒病學雜誌
중국개입심장병학잡지
CHINESE JOURNAL OF INTERVENTIONAL CARDIOLOGY
2014年
8期
483-487
,共5页
张奇%张瑞岩%胡健%杨震坤%张建盛%丁风华%朱天奇%朱政斌%张宪%黄怡琳%沈卫峰
張奇%張瑞巖%鬍健%楊震坤%張建盛%丁風華%硃天奇%硃政斌%張憲%黃怡琳%瀋衛峰
장기%장서암%호건%양진곤%장건성%정풍화%주천기%주정빈%장헌%황이림%침위봉
心肌梗死%血管成形术%支架%替罗非班%预后
心肌梗死%血管成形術%支架%替囉非班%預後
심기경사%혈관성형술%지가%체라비반%예후
Myocardial infarction%Angioplasty%Stent%Tirofiban%Prognosis
目的：比较直接经皮冠状动脉介入治疗（PCI）前（急诊室）早期静脉负荷/维持应用和单纯术中冠状动脉（冠脉）内注射替罗非班对PCI术后即刻心肌灌注及术后30 d主要不良心脏事件（MACE）发生率的影响。方法回顾性分析707例连续性急性ST段抬高心肌梗死（STEMI）接受直接PCI患者，其中PCI时单纯冠脉内注射替罗非班（25μg/kg）86例（观察组），急诊室开始应用替罗非班[静脉负荷10μg/kg，随后0.15μg/（kg·min）静脉维持]239例（对照组）。比较两组一般临床资料、造影特征、介入治疗、术后30 d MACE及出血事件发生率。结果观察组患者年龄[（63.8±11.4）岁比（57.9±8.8）岁，P=0.01]、女性（40.7%比25.1%，P=0.006）、高血压（58.6%比51.0%，P=0.005）及多支冠脉病变（57.0%比34.3%，P＜0.001）比例高于对照组。术前两组冠脉罪犯血管分布和TIMI血流相似；术后即刻，两组TIMI血流、心肌灌注分级（TMP）比较，差异均无统计学意义（P=0.66、P=0.48）。住院期间，观察组TIMI微出血发生率明显低于对照组（2.3%比9.6%，P=0.03），两组院内MACE发生率和术后30 d无MACE生存率比较，差异均无统计学意义（P=0.72、P=0.48）。结论与早期静脉负荷及维持应用替罗非班相比，急诊PCI时单纯冠脉内注射替罗非班对患者术后30 d临床预后作用相似，但院内出血事件更少。将来仍需前瞻性临床随机试验进一步验证研究结论。
目的：比較直接經皮冠狀動脈介入治療（PCI）前（急診室）早期靜脈負荷/維持應用和單純術中冠狀動脈（冠脈）內註射替囉非班對PCI術後即刻心肌灌註及術後30 d主要不良心髒事件（MACE）髮生率的影響。方法迴顧性分析707例連續性急性ST段抬高心肌梗死（STEMI）接受直接PCI患者，其中PCI時單純冠脈內註射替囉非班（25μg/kg）86例（觀察組），急診室開始應用替囉非班[靜脈負荷10μg/kg，隨後0.15μg/（kg·min）靜脈維持]239例（對照組）。比較兩組一般臨床資料、造影特徵、介入治療、術後30 d MACE及齣血事件髮生率。結果觀察組患者年齡[（63.8±11.4）歲比（57.9±8.8）歲，P=0.01]、女性（40.7%比25.1%，P=0.006）、高血壓（58.6%比51.0%，P=0.005）及多支冠脈病變（57.0%比34.3%，P＜0.001）比例高于對照組。術前兩組冠脈罪犯血管分佈和TIMI血流相似；術後即刻，兩組TIMI血流、心肌灌註分級（TMP）比較，差異均無統計學意義（P=0.66、P=0.48）。住院期間，觀察組TIMI微齣血髮生率明顯低于對照組（2.3%比9.6%，P=0.03），兩組院內MACE髮生率和術後30 d無MACE生存率比較，差異均無統計學意義（P=0.72、P=0.48）。結論與早期靜脈負荷及維持應用替囉非班相比，急診PCI時單純冠脈內註射替囉非班對患者術後30 d臨床預後作用相似，但院內齣血事件更少。將來仍需前瞻性臨床隨機試驗進一步驗證研究結論。
목적：비교직접경피관상동맥개입치료（PCI）전（급진실）조기정맥부하/유지응용화단순술중관상동맥（관맥）내주사체라비반대PCI술후즉각심기관주급술후30 d주요불양심장사건（MACE）발생솔적영향。방법회고성분석707례련속성급성ST단태고심기경사（STEMI）접수직접PCI환자，기중PCI시단순관맥내주사체라비반（25μg/kg）86례（관찰조），급진실개시응용체라비반[정맥부하10μg/kg，수후0.15μg/（kg·min）정맥유지]239례（대조조）。비교량조일반림상자료、조영특정、개입치료、술후30 d MACE급출혈사건발생솔。결과관찰조환자년령[（63.8±11.4）세비（57.9±8.8）세，P=0.01]、녀성（40.7%비25.1%，P=0.006）、고혈압（58.6%비51.0%，P=0.005）급다지관맥병변（57.0%비34.3%，P＜0.001）비례고우대조조。술전량조관맥죄범혈관분포화TIMI혈류상사；술후즉각，량조TIMI혈류、심기관주분급（TMP）비교，차이균무통계학의의（P=0.66、P=0.48）。주원기간，관찰조TIMI미출혈발생솔명현저우대조조（2.3%비9.6%，P=0.03），량조원내MACE발생솔화술후30 d무MACE생존솔비교，차이균무통계학의의（P=0.72、P=0.48）。결론여조기정맥부하급유지응용체라비반상비，급진PCI시단순관맥내주사체라비반대환자술후30 d림상예후작용상사，단원내출혈사건경소。장래잉수전첨성림상수궤시험진일보험증연구결론。
Objective To analyse and compare the effects and safety of early use (in emergency room, intravenous loading followed by infusion) with bolus injection during primary PCI of tirofiban, on post-procedural TIMI flow and 30d clinical outcomes. Methods Seven hundred and seven patients with acute STEMI treated by primary PCI in Ruijin hospital were retrospectively and enrolled screened. Among them, 86 patients with single bolus intra-coronary injection of tirofiban (25 μg/kg) during the procedure were served as observation group. Baseline, angiographic, PCI features and rate of major adverse cardiac events (MACE) at 30 d follow-up were compared with those received early intravenous infusion of tirofiban (10ug/kg bolus followed by 0.15μg/(kg·min) intravenous infusion)(control group, n=239). Results Compared with control group, patients in observation group were older[(63.8±11.4) vs. (57.9±8.8), P=0.01], had higher prevalence of hypertension (58.6%vs. 51.0%, P=0.005), multivessel disease (57.0%vs. 34.3%, P<0.001), and female in gender (40.7%vs. 25.1%, P=0.006). Post-procedural TIMI flow in culprit vessel and TMP grade were comparable between the two groups (P=0.66 and P=0.48, respectively). Reduction in TIMI minimal bleeding events were found in the observation group (2.3%vs. 9.6%, P=0.03). MACE free survival rate at 30d clinical follow-up was similar between the two groups (P=0.48). Conclusions Single bolus intra-coronary injection of tirofiban exerts similar effects in post-procedural TIMI flow, TMP grade in culprit vessel and 30d clinical outcomes compared with early use in emergency room with intra-venous loading and infusion, nevertheless, intra-coronary injection resulted in significantly reduced TIMI minimal bleeding events. Prospective, randomized clinical study is mandatory to prove our current results.
