摘要
目的评价小剂量血小板糖蛋白Ⅱb／Ⅲa受体拮抗剂替罗非班应用于CRUSADE评分高出血风险的急性ST段抬高心肌梗死（ASTEMI）患者急诊介入治疗（PCI）的安全性和有效性。方法89例CRUSADE评分〉40且接受急诊PCI的ASTEMI患者按照替罗非班使用剂量分为小剂量组（n=51）和常规剂量组（n=38），两组在常规使用阿司匹林及氯吡格雷双联抗血小板药物的基础上，术中及术后分别使用小剂量[负荷量5μg／kg，继而0．075μg／（kg·min）静脉泵入维持24～48h]和常规剂量[负荷量10μg／kg，继而0．15μg／（kg．min）静脉泵入维持24～48h]替罗非班，观察PCI术后7d及30d主要心血管不良事件（死亡、再发心肌梗死、再发心绞痛和靶血管再次血运重建）、术后7d出血事件和血小板减少等不良反应的发生情况。结果小剂量组与常规剂量组基线资料差异无统计学意义。PCI术后7d，小剂量组2例发生再发心肌梗死，1例再发心绞痛；常规剂量组1例死亡（死亡原因为心脏破裂），1例发生心肌再梗死。术后30d两组均无新增死亡病例及靶血管再次血运重建病例，小剂量组2例再发心绞痛，常规剂量组1例再发心绞痛。两组主要心血管不良事件发生率差异无统计学意义（P〉0．05）。术后7d，小剂量组有3例发生穿刺部位血肿（均为股动脉穿刺部位），1例牙龈出血；常规剂量组发生7例穿刺部位血肿（其中6例为股动脉穿刺，1例为桡动脉穿刺）．1例血尿，1例牙龈出血，3例严重消化道出血，1例颅内出血。小剂量组总的出血发生率显著低于常规剂量组（P〈0．01）。小剂量组及常规剂量组各有1例发生血小板减少，差异无统计学意义（P〉0．05）。结论小剂量替罗非班应用于CRUSADE评分高出血风险的ASTEMI患者急诊PCI与常规剂量同样有效。且出血发生率更低，安全性更好。
Objective To evaluate the effect and safety of low-dose tirofiban on emergent percutaneous coronary intervention （PCI） for patients with high CRUSADE score with acute ST segment elevation myocardial infarction （ASTEMI）. Methods Eightynine patients with CRUSADE score 〉40 were divided into low-dose group （n=S1） and standard-dose group （n=38）. Tirofiban was administered intracoronarily with a bolus of 5μg/kg or 10μg/kg during PCI and followed by a 24-48h infusion with intravenous administration of 0.075μg/（kg.min） or 0.15μg/（kg.min） respectively. The major adverse cardiac events （MACEs） including death, recurrent myocardial infarction, recurrent angina and target vessel revascularization at 7th and 30th day after PCI and the adverse effects including bleeding events and thrombocytopenia at 7th day were recorded and analyzed. Results No significant difference existed in baseline and dinical data of patients in the two groups. At the 7th day, there were 2 cases of recurrent myocardial infarction and 1 case of recurrent angina in the low-dose group; 1 case of death （cardiac rupture） and 1 case of recurrent myocardial infarction in the standard-dose group. At the 30th day, there were 2 cases and 1 case of recurrent angina respectively in the low-dose group and standard-dose group. No significant difference was found in MACEs at 7th and 30th day （P〉0.05）. At the 7th day, there were 3 cases ofhematoma at the femoral puncture site and 1 case of gum bleeding in the low-dose group; 7 cases of hematoma （6 at the femoral puncture site and 1 at the radial site）, 1 case of hematuria, 1 case of gum bleeding, 3 cases of major gastrointestinal bleeding and 1 case of intracranial hemorrhage in the standard-dose group. The rate of bleeding events was significantly higher lower in low-dose group than in standard group （7.8% vs 34.2%, P〈0.01）. No significant difference was found in the adverse effect ofthrombocytopenia at 7th day （P〉0.05）. Conclusion It is effective and more safe to administer low-dose tirofiban in emergent PCI of ASTEMI for patients with high CRUSADE score.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2014年第6期481-484,共4页
Medical Journal of Chinese People's Liberation Army
关键词
替罗非班
出血
心肌梗死
血管成形术
经腔
经皮冠状动脉
tirofiban
hemorrhage
myocardial infarction
angioplasty, transluminal, percutaneous coronary
