CAJ | 학술논문

目的研究老年急性冠状动脉综合征(ACS)患者经皮冠状动脉介入(PCI)术中应用无负荷量替罗非班的有效性及安全性.方法将180例老年ACS患者按入院顺序随机分为替罗非班非负荷量组、负荷量组和对照组,各60例.非负荷量组PCI术中(导丝通过病变后即刻)替罗非班以0.15 μg/(kg·min)的剂量维持静脉滴注24 h,负荷量组PCI术中替罗非班以10μg/kg于3 min内推注完毕,后0.15 μg/(kg·min)的剂量维持静脉滴注24 h.对照组不使用替罗非班.比较3组术中、术后血小板聚集率的水平,PCI术后即刻罪犯血管(CV)的心肌梗死溶栓试验(TIMI)血流分级,术前与术后心肌酶[肌酸激酶(CK),肌酸激酶同工酶(CK-MB),乳酸脱氢酶(LDH),心肌肌钙蛋白Ⅰ(cTn Ⅰ)]变化,以及术后30 d内的主要不良心血管事件(MACE)、术后出血的发生率.结果与对照组相比,替罗非班非负荷量组和负荷量组血小板聚集率明显下降,术后心肌酶水平明显降低,30 d内的MACE事件发生率也降低[血小板聚集率:用药后12h对照组(58.5±1.5)％、非负荷量组(28.6±1.4)％、负荷量组(32.6±3.2)％,用药后24 h对照组(57.9±2.3)％、非负荷量组(44.2±1.7)％、负荷量组(46.1±1.9)％；心肌酶CK-MB:对照组(16.6±3.5)U/L、非负荷量组(13.3±2.2)U/L、负荷量组(12.5 ±4.0) U/L;LDH:对照组(298 ±61) U/L、非负荷量组(245±52) U/L、负荷量组(257 ±48)U/L;cTn Ⅰ:对照组(0.78 ±0.17) μg/L、非负荷量组(0.37 ±0.18) μg/L、负荷量组(0.28±0.23) μg/L;30d内的MACE事件发生率:3.3％(2/60)、1.7％(1/60)比13.3％ (8/60),均P＜0.05].非负荷量组和负荷量组血小板聚集率、心肌酶水平、CV的TIMI血流分级、30 d内的MACE事件、出血并发症发生率比较,差异均无统计学意义(均P＞0.05).结论老年ACS患者介入术中使用无负荷量替罗非班,能明显降低血小板聚集率,改善CV的TIMI血流,减少不良心脏事件.
목적 연구노년급성관상동맥종합정(ACS)환자경피관상동맥개입(PCI)술중응용무부하량체라비반적유효성급안전성.방법 장180례노년ACS환자안입원순서수궤분위체라비반비부하량조、부하량조화대조조,각60례.비부하량조PCI술중(도사통과병변후즉각)체라비반이0.15 μg/(kg·min)적제량유지정맥적주24 h,부하량조PCI술중체라비반이10μg/kg우3 min내추주완필,후0.15 μg/(kg·min)적제량유지정맥적주24 h.대조조불사용체라비반.비교3조술중、술후혈소판취집솔적수평,PCI술후즉각죄범혈관(CV)적심기경사용전시험(TIMI)혈류분급,술전여술후심기매[기산격매(CK),기산격매동공매(CK-MB),유산탈경매(LDH),심기기개단백Ⅰ(cTn Ⅰ)]변화,이급술후30 d내적주요불양심혈관사건(MACE)、술후출혈적발생솔.결과 여대조조상비,체라비반비부하량조화부하량조혈소판취집솔명현하강,술후심기매수평명현강저,30 d내적MACE사건발생솔야강저[혈소판취집솔:용약후12h대조조(58.5±1.5)％、비부하량조(28.6±1.4)％、부하량조(32.6±3.2)％,용약후24 h대조조(57.9±2.3)％、비부하량조(44.2±1.7)％、부하량조(46.1±1.9)％；심기매CK-MB:대조조(16.6±3.5)U/L、비부하량조(13.3±2.2)U/L、부하량조(12.5 ±4.0) U/L;LDH:대조조(298 ±61) U/L、비부하량조(245±52) U/L、부하량조(257 ±48)U/L;cTn Ⅰ:대조조(0.78 ±0.17) μg/L、비부하량조(0.37 ±0.18) μg/L、부하량조(0.28±0.23) μg/L;30d내적MACE사건발생솔:3.3％(2/60)、1.7％(1/60)비13.3％ (8/60),균P＜0.05].비부하량조화부하량조혈소판취집솔、심기매수평、CV적TIMI혈류분급、30 d내적MACE사건、출혈병발증발생솔비교,차이균무통계학의의(균P＞0.05).결론 노년ACS환자개입술중사용무부하량체라비반,능명현강저혈소판취집솔,개선CV적TIMI혈류,감소불양심장사건.
Objective To investigate the efficacy and safety of tirofiban without load dose for elderly patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods One hundred and eighty cases of ederly patients with ACS were randomly divided into tirofiban non-load group,load group and control group.The tirofiban non-load group (n =60) were given tirofiban without load dose [maintaining dose of 0.15 μg/(kg · min) iv drip for 24 h].The tirofiban load group (n =60) was given tirofiban with load dose [10 μg/kg iv within 3 min ; maintaining dose 0.15 μg/(kg · min) iv drip for 24 h].The control group (n =60)was not given tirofiban.Results Compared with the contral group during PCI,the platelet aggregation rate(PAR) was much lower when tirofian was used for 24 hours either with or without load dose [12 h:(28.6 ± 1.4)％,(32.6±3.2)％ vs (58.5±1.5)％; 24 h:(44.7±1.7)％,(46.1 ±1.9)％,vs (57.9±2.3)％,P＜0.05],the incidence of major adverse cardiac events within 30 days decreased significantly [3.3％ (2/60),1.7％ (1/60)vs 13.3％ (8/60),P ＜ 0.05].Bleeding complications were not increased significantly (P ＞ 0.05).Compared with the two subgroups using tirofiban,there was no significant difference in PAR,CK-MB,flow of the target vessel and bleeding complications.But there was a decreasing tendency of the incidence of bleeding in the treatment group without load dose.Conclusion Tirofiban without load dose is safe and effective in the treatment of elderly patients with ACS undergoing PCI.