替罗非班对急性心肌梗死经皮冠状动脉介入治疗中无复流现象的影响

目的观察血小板糖蛋白GPⅡb/Ⅲa受体拮抗剂盐酸替罗非班对ST段抬高型急性心肌梗死(STEAMI)患者经皮冠状动脉介入治疗(PCI)中无复流现象的影响.方法选择2006年1月至2006年12月哈尔滨医科大学第一附属医院心内科急诊入院的STEAMI患者104例,急诊冠状动脉造影结束后,按就诊顺序随机分为盐酸替罗非班组和对照组,观察两组PCI术后TIMI血流情况,24 h和1周心电图ST段回落情况2、4 h及30 d复合心血管终点事件发生率及出血情况.结果替罗非班组PCI术后TIMI 3级血流发生率92.3%,TIMI 0~2级血流发生率7.7%;对照组TIMI 3级血流发生率80.7%,TIMI 0~2级血流发生率19.3%,两组比较差异有统计学意义(P<0.05).替罗非班组24 h和1周心电图ST段完全回落率较对照组大(P<0.05).两组住院期间主要复合终点心血管事件发生率无显著差异(P>0.05),但替罗非班组有下降趋势.两组均无严重出血事件发生.结论急性心肌梗死直接PCI中应用盐酸替罗非班,可以改善术后梗死相关动脉无复流现象.

Effect of tirofiban on no-reflow phenomenon during primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective To evaluate the effect of platelet GPⅡb/Ⅲa antagonist Tirofiban on no-reflow phenomenon during primary percutaneous coronary intervention(PCI) in patients with ST segment elevation acute myocardial infarction(STEAMI).Methods One hundred and four STEAMI patients who underwent primary PCI in Harbin Medical University from Jan 2006 To Dec 2006 were enrolled.Patients were divided randomly into two groups: Tirofiban group and control(without Tirofiban) group.TIMI flow grade after PCI and complete ST segment resolution at 24 hours and one week later were analyzed.The composite primary end point event and bleeding complication at 24 hours and 30 days were also recorded. Results In tirofiban group,92.3% patients were recovered with TIMI 3 grade flow after PCI and 7.7% of patients were recovered with TIMI 0-2 grade flow;in control group,80.7% of patients restored TIMI 3 grade and 19.3% of patients were recovered with TIMI 0-2 grade flow.The difference was statistically significant(P<0.05).Rate of complete ST resolution was higher in Tirofiban group than in control group(P<0.05).Composite primary end point events and bleeding complication at 24 hours and 30 days were not significantly different between Tirofiban group and control group. Conclusions Tirfiban used during PCI treatment for STEAMI can effectively prevent no-reflow phenomenon.