CAJ | 학술논문

目的：评价不同时机应用替罗非班干预急性心肌梗死经皮冠状动脉介入治疗(PCI)的临床疗效与安全性。方法纳入2012年1月至2013年6月在我院心内科行PCI术治疗的急性心肌梗死患者96例。随机分为试验1组(术前应用替罗非班)34例、试验2组(术后应用替罗非班)30例和对照组(空白组)32例。观察三组患者术后冠脉造影血流情况、心电图、左心收缩舒张功能及不良反应，并随访半年观察重大心血管事件发生情况。结果术后疗效比较，试验1组冠脉血流优于试验2组及对照组(P<0.05)；试验1组相关导联ST段回落值大于其他两组(P<0.01)，差异均有统计学意义。试验1组和2组患者的不良反应及随访重大心血管事件发生率与对照组比较，差异均无统计学意义(P>0.05)。结论急性心梗的患者PCI术前应用替罗非班能够有效改善冠状动脉血流、心肌灌注及心功能，安全性尚可。术前应用可能是临床上应用替罗非班的合理时机。
목적：평개불동시궤응용체라비반간예급성심기경사경피관상동맥개입치료(PCI)적림상료효여안전성。방법납입2012년1월지2013년6월재아원심내과행PCI술치료적급성심기경사환자96례。수궤분위시험1조(술전응용체라비반)34례、시험2조(술후응용체라비반)30례화대조조(공백조)32례。관찰삼조환자술후관맥조영혈류정황、심전도、좌심수축서장공능급불량반응，병수방반년관찰중대심혈관사건발생정황。결과술후료효비교，시험1조관맥혈류우우시험2조급대조조(P<0.05)；시험1조상관도련ST단회락치대우기타량조(P<0.01)，차이균유통계학의의。시험1조화2조환자적불량반응급수방중대심혈관사건발생솔여대조조비교，차이균무통계학의의(P>0.05)。결론급성심경적환자PCI술전응용체라비반능구유효개선관상동맥혈류、심기관주급심공능，안전성상가。술전응용가능시림상상응용체라비반적합리시궤。
Objective To analyze the effectiveness and security of different timing use of tirofiban in pa-tients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods Nine-ty-six patients of AMI treated with PCI in Department of Cardiology of our hospital from Jan. 2012 to Jun. 2013 were enrolled and divided into experimental group 1 (treated with tirofiban before PCI, n=34) , experimental group 2 (treat-ed with tirofiban after PCI, n=30) and control group (injection of normal saline for 20 ml, n=32). The coronary blood flow, ECG, left ventricular function and adverse reactions after operation were observed. Furthermore, the major ad-verse reactions on cardiovascular events were examined consecutively for the following six months. Results Coro-nary blood flow of experimental group 1 was better than those of the other two groups (t=-2.423, P=0.018). The ECG ST-segment-related value in experimental group 1 was higher than those in the other two groups with statistical differ-ence (t=4.011, P<0.001). There was no statistical significant difference in MACE rate and adverse reactions between the two experimental groups and the control group. Conclusion Use of tirofiban before PCI in patients with acute coronary syndromes can improve coronary blood flow, myocardial perfusion and cardiac function, with less adverse re-actions, which may be regarded as a reasonable timing in clinical practice.