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目的:观察经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中冠脉内注射替罗非班(tirofiban)治疗急性ST段抬高型心肌梗死(ST-segment elevated myocardial infarction,STEMI)的临床效果。方法:将82例STEMI患者采用完全随机化方法分为观察组(41例)和对照组(41例)。观察组在冠脉造影后冠脉内注射替罗非班0.5 mg,对照组在冠脉造影后静脉内推注替罗非班0.5 mg,之后2组维持静滴替罗非班36 h,维持静滴速率0.1μg·kg-1·min-1。观察PCI前后TIMI3级血流发生率、心电图ST段回落良好率、主要心血管事件率和出血风险。结果:观察组PCI术后TIMI3级血流发生率、心电图ST段回落良好率均显著高于对照组(P<0.05);PCI术后住院期间主要心血管事件率显著低于对照组(P<0.05);2组出血风险无明显差异(P>0.05)。结论:PCI术中冠脉内注射替罗非班治疗急性STEMI能够明显改善梗死相关血管前向血流TIMI分级,改善无复流/慢血流情况,减少术后住院心血管事件的发生,且不增加出血风险。
Objective: To observe the clinical effect of intracoronary injection of tirofiban on acute ST-segment elevation myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) effect. Methods: 82 cases of STEMI patients were divided into observation group (41 cases) and control group (41 cases) by randomized method. In the observation group, 0.5 mg of tirofiban was injected into the coronary artery after coronary angiography, while in the control group, 0.5 mg of tirofiban was injected intravenously after coronary angiography. In the control group, intravenous tirofiban was maintained for 36 h The infusion rate was 0.1 μg · kg-1 · min-1. The incidence of TIMI 3 grade blood flow, the rate of ECG ST-segment regression, the prevalence of major cardiovascular events and the risk of bleeding were observed before and after PCI. Results: The TIMI grade 3 blood flow rate and ST-segment depression rate were significantly higher in the observation group after PCI than those in the control group (P <0.05). The main cardiovascular events during PCI in the observation group were significantly lower than those in the control group (P < 0.05). There was no significant difference in bleeding risk between the two groups (P> 0.05). Conclusions: Intracoronary injection of tirofiban in the treatment of acute STEMI can significantly improve TIMI classification of infarct-related vascular antegrade flow, improve the condition of no-reflow / slow blood flow and reduce the postoperative incidence of hospitalized cardiovascular events, and Does not increase the risk of bleeding.