CAJ | 학술논문

目的：研究替罗非班在急性ST段抬高型心肌梗死急诊PCI术前、术中应用的疗效差异。方法：选择本院收治的112例急性ST段抬高型心肌梗死患者，患者均行急诊PCI术，两组常规用药无差异。随机分为对照组与观察组，各56例。观察组在急性ST段抬高型心肌梗死患者入院后即刻给予盐酸替罗非班直至PCI术后48 h，对照组患者在术中使用替罗非班直至PCI术后48 h。比较两组的自发冠脉再通率、PCI术后慢血流、无复流发生率、LVEF值、BNP（脑钠肽）、Killip分级，主要心血管不良事件、以及出血并发症等发生情况。结果：两组术前指标无显著差异，观察组术中冠脉罪犯血管再通率、PCI术后慢血流发生率明显优于对照组，治疗后1周观察组BNP、主要心血管不良事件、左心功能均明显优于对照组（P＜0.05），两组未发现严重出血事件。结论：急性ST段抬高型心肌梗死急诊PCI术前开始应用替罗非班比术中开始应用替罗非班疗效更好，能提高冠脉罪犯血管自通率，缩短缺血心肌复流时间，降低冠脉PCI术后无复流发生率，进一步改善心功能及主要心血管事件的发生率，安全有效。
목적：연구체라비반재급성ST단태고형심기경사급진PCI술전、술중응용적료효차이。방법：선택본원수치적112례급성ST단태고형심기경사환자，환자균행급진PCI술，량조상규용약무차이。수궤분위대조조여관찰조，각56례。관찰조재급성ST단태고형심기경사환자입원후즉각급여염산체라비반직지PCI술후48 h，대조조환자재술중사용체라비반직지PCI술후48 h。비교량조적자발관맥재통솔、PCI술후만혈류、무복류발생솔、LVEF치、BNP（뇌납태）、Killip분급，주요심혈관불량사건、이급출혈병발증등발생정황。결과：량조술전지표무현저차이，관찰조술중관맥죄범혈관재통솔、PCI술후만혈류발생솔명현우우대조조，치료후1주관찰조BNP、주요심혈관불량사건、좌심공능균명현우우대조조（P＜0.05），량조미발현엄중출혈사건。결론：급성ST단태고형심기경사급진PCI술전개시응용체라비반비술중개시응용체라비반료효경호，능제고관맥죄범혈관자통솔，축단결혈심기복류시간，강저관맥PCI술후무복류발생솔，진일보개선심공능급주요심혈관사건적발생솔，안전유효。
Objective:To observe the outcomes of tirofiban administered before or during an emergency percutaneous coronary intervention ( PCI) for pa-tients with acute ST-elevation myocardial infarction (STEMI).Methods:112 patients with STEMI admitted to our hospital underwent emergent PCI,and were randomly divided into the pre-PCI group ( Tirofiban administered immediately after admission through post-operative 48 h, n =56 ) and intra-PCI group(Tirofiban started inraoperatively through 48 h after intervention,n=56)on the similar conventional medication basis.The two groups were compared regarding the rate of spontaneous coronary recanalization,incidences of slow flow or no-reflow after PCI,left ventricular ejection fraction (LVEF),level of brain natriuretic peptide(BNP) (brain natriuretic peptide),the Killip classification,major adverse cardiovascular events (MACE) and vascular hemor-rhage.Results:The baseline characteristics before PCI were not significant between the two groups.However,better results,including the rate of recanaliza-tion of crime coronary during PCI,fewer incidence of slow flow after PCI,reduced BNP level and fewer MACE as well as improved LVEF one week after treatment,were observed in the pre-PCI group as compared with the intra-PCI group (P<0.05).No serious vascular bleeding occurred in the two groups. Conclusion:Tirofiban can be safely administered before or during the PCI for patients with acute STEMI ,and yet,pre-PCI administration of this agent may achieve better results in improving the recanalization of crime coronary ,decreasing the reflow time for the ischemic myocardium ,lowering the incidence of no-reflow after PCI,boosting the cardiac function and reducing the cardiovascular complications.