摘要
目的比较急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)中冠状动脉内注射不同剂量替罗非班的疗效。方法选择2015年4月至2017年10月在诊断为STEMI并行急诊PCI的患者采用随机数字表法分为低剂量组(术中冠状动脉内推注替罗非班10μg/kg)和高剂量组(术中冠状动脉内推注替罗非班25μg/kg),术后两组均按0.1μg/(kg·min)微泵持续静推维持至36h。比较冠状动脉梗死相关血管即刻TIMI血流、术后2h心电图ST段回落率(STR)、术后10~15d超声心动图的左心室舒张末径(LVEDD)、左心室射血分数(LVEF)、术后30d主要心血管事件。结果共纳入136例患者,术前两组一般资料可比(P>0.05)。高剂量组TIMI血流3级比率(88.2%)、术后STR(85.29%)比率均高于低剂量组(58.8%、57.32%),差异有统计学意义(χ~2=8.83、0.388,均P<0.05)。术后高剂量组LVEDD(41.26±3.62)mm、MACE发生率(8.8%)低于低剂量组[(50.68±5.64)mm、16.1%],LVEF[(55.63±5.52)%]高于低剂量组[(40.82±5.58)%],差异均有统计学意义(χ~2/t=-3.41、1.038、3.62,均P<0.05)。结论冠状动脉内注入高剂量替罗非班有利于提高STEMI患者PCI的疗效和改善近期预后。
Objective To compare the efficacy of different dose intracoronary tirofiban during primary percutaneouscoronary intervention （PPCI） in patients with ST-elevation myocardial infarction （STEMI）. Methods STEMI patientsundergoing PPCI from April 2015 to October 2017 were randomly assigned to low-dose tirofiban group （10μg/kgintracoronary bolus） and high-dose tirofiban group（25μg/kg intracoronary bolus）. Intravenous tirofiban（0.1μg· kg^-1· min^-1）maintained for 36h after PPCI in both groups. Thrombolysis in myocardial infarction （TIMI） grade, ST- segment recoveryrate （STR） at 2h after operation, left ventricular end diastolic diameter （LVEDd） and left ventricular ejection fraction （LVEF）on echocardiography during 10-15days and major adverse cardiac events （MACE） at 30 days post operation werecompared. Results A total of 136 cases were enrolled. Baseline data were similar between the two groups. The ratio ofTIMI flow grade 3 and STR were significantly higher in high-dose tirofiban group than in low-dose tirofiban group. LVEDdand MACE incidence were significantly lower and LVEF was significantly higher in high-dose tirofiban group than inlow-dose tirofiban group. Conclusion Intracoronary bolus of high-dose tirofiban may improve PPCI efficacy andshort-term prognosis of patients with STEMI.
作者
房兆飞
陈国雄
王红娜
方波
孔倩雯
邹金林
邬小花
FANG ZhaoFei;CHEN GuoXiong;WANG Hongna(Cardiology Departmentof Zhoushan＇s Hospital,Zhoushan 316000,China)
出处
《心电与循环》
2018年第6期385-389,共5页
Journal of Electrocardiology and Circulation
基金
舟山市科技局项目(2016C3040)
关键词
替罗非班
冠状动脉内注射
急性ST段抬高型心肌梗死
急诊冠状动脉介入
Tirofiban
Intracoronary injection
ST-segment elevation myocardial infarction
Primary percutaneous
coronary intervention
