摘要
目的探讨替罗非班的应用时机对行冠脉介入治疗(PCI)的高危非ST段抬高型急性冠脉综合征(NSTE-ACS)患者近期临床预后的影响。方法160例高危NSTE-ACS患者随机分为PCI术前早期应用组(Ⅰ组,冠脉造影前4～6h应用替罗非班)和PCI术前即刻应用组(Ⅱ组,导丝通过冠脉病变后应用替罗非班)。分析两组靶血管的心肌梗死溶栓试验(TI MI)血流分级和TI MI心肌灌注分级(TMPG)的差异。随访PCI术后24h、3d、7d和30d内主要不良心血管事件(MACE)的发生率,并记录使用替罗非班治疗期间的出血并发症和血小板减少症的发生率。结果Ⅰ组术前即刻靶血管TI MI血流2～3级(81%)和TMPG灌注2～3级(62%)的比率均显著高于Ⅱ组(分别为62%和33%,P<0.05)。两组PCI术后靶血管TI MI血流3级比率无统计学差异(P>0.05)。Ⅰ组术后TMPG灌注2～3级比率(89%)显著高于Ⅱ组(64%,P<0.05)。两组PCI术后24h和3d内均未发生MACE,7d MACE发生率均为1.25%,两组30d内MACE的发生率分别为3.75%和6.25%(P>0.05)。使用替罗非班治疗期间,两组重度出血的发生率分别为2.50%和1.25%(P>0.05),中度出血并发症和轻度血小板减少症的发生率均为1.25%。结论在应用阿司匹林、氯吡格雷行抗血小板治疗的基础上,高危NSTE-ACS患者于PCI术前早期(4～6h)应用替罗非班较PCI术前即刻应用,能更显著改善冠脉血流和心肌灌注,并有降低PCI术后30d内MACE发生率的趋势。
Objective To evaluate the effects of upstream and downstream administration of tirofiban on short term clinical prognosis in patients with high risk non-ST-segment elevation acute coronary syndrome （NSTE-ACS） who underwent percutaneous coronary in tervention （PCI）. Methods One hunderd and sixty patients with high-risk NSTE-ACS undergone PCI were randomized to upstream group （abbreviated as Group Ⅰ, tirofiban was given within 4 6 hours before coronary angiography） and downstream group （abbreviated as Group Ⅱ, tirofiban was given when the wire passed the coronary artery lesions just prior to PCI）. The difference of thrombolysis in myocardial infarction （TIMI） flow grade and the TIMI myocardial perfusion grade （TMPG） of target arteries before and after PCI were examined in the 2 groups. The incidences of major-adverse-cardiovascular-event （MACE） at 24h, 3d, 7d and 30d follow-up were recorded, and also were the incidences of bleeding complications and thrombocytopenia during timfiban administration. Results The TIMI grade 2-3 flow and TMPG 2-3 perfusion were significantly more fraquently observed in group Ⅰ （81% and 62 %, respectively） compared with that in group Ⅱ （62% and 33%, respectively, P〈0.05）. The TIMI grade 3 flow in group Ⅰ （99M） showed similar result to that in group Ⅱ （98%, P〉0. 05） after PCI, but TMPG 2-3 perfusion in group Ⅰ（89%） was significantly better TMPG 2-3 periuslon compared wath that in group Ⅱ（64%, P〈0. 05）. No MACE was observed in the two groups at 24h and 3d follow-up after PCI, while the incidence of MACE at 7d follow- up was 1.25o//00 in both groups. At 30d follow-up, the incidences of MACE were 3.75% and 6. 25% in group Ⅰ and group Ⅱ, respectively （P〉0.05）. Severe bleeding complications occurred in 2. 50% of patients in group Ⅰ and 1.25% in group Ⅱ（ P〉0. 05）, and all the incidences of moderate bleeding complications and thrombopenia were 1.25 % in both groups during tirofiban administration. Cmwlusions Based on the pretreatment with aspirin and dopidogrel, upstream administration of tirofiban （4-6 hours before PCI） may markedly improve the coronary flow and myocardial peffusion, and reduce the risk of MACE during 30d postoperation among the high-risk NSTE-ACS patients.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2009年第2期131-134,共4页
Medical Journal of Chinese People's Liberation Army
基金
北京市保健专项资金科研课题(京06-04号)
作者简介
刘弢，医学硕士，住院医师。主要从事心血管疾病方面的研究。现工作单位北京市大兴区人民医院急诊内科
[通讯作者]谢英，Email：xieying@medmail．com．cn
