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目的评价替罗非班对急性ST段抬高心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗术(PCI)后的心肌灌注和心功能的临床疗效。方法选择2009年1月至2010年3月收治的STEMI患者100例,随机分为替罗非班组和对照组,每组50例。替罗非班组在PCI前,在常规给药基础上静脉推注替罗非班10μg/kg,3min内注完。后予0.15μg/(kg.min)替罗非班静脉滴注36h,对照组只常规给药,不予替罗非班。冠状动脉造影观察术后冠状动脉血流TIMI分级,术后90min计算心电图ST段回落幅度,术后1周内超声心动图测定左心室射血分数(LVEF)。结果①PCI术后TIMI0～2级者,对照组29例,替罗非班组10例,2组比较有显著性差异(P<0.05);TIMI3级者,对照组21例,替罗非班组40例,2组比较有显著性差异(P<0.05)。②替罗非班组术后心电图ST段迅速回落者17例,对照组10例,2组比较有显著性差异(P<0.05)。③替罗非班组LVEF(60±8),显著高于对照组的(53±10)(P<0.05)。结论 STEMI患者直接PCI联合使用替罗非班治疗可以改善术后冠状动脉血流及心功能指标。
Objective To evaluate the clinical effect of tirofiban on myocardial perfusion and cardiac function after direct percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods One hundred patients with STEMI admitted from January 2009 to March 2010 were randomly divided into tirofiban group and control group, 50 cases in each group. Tirofiban group before PCI, on the basis of conventional administration of intravenous tirofiban 10μg / kg, 3min note. After given 0.15μg / (kg.min) Tirofiban intravenously 36h, the control group only conventional administration, not tirofiban. Coronary artery angiography was performed to observe the grade of coronary flow in the postoperative TIMI. The ST segment decline amplitude was calculated 90 min after the operation. Left ventricular ejection fraction (LVEF) was measured by echocardiography within one week after operation. Results ① The TIMI grade 2 ~ 2 patients in the control group were 29 cases in the control group, 10 cases in the tirofiban group, there was significant difference between the 2 groups (P <0.05); TIMI grade 3 in the control group, 21 cases in the control group and 40 cases in the tirofiban group There was significant difference between the two groups (P <0.05). (2) Tirofiban group postoperative ECG ST-segment rapid decline in 17 cases, the control group of 10 cases, the two groups were significantly different (P <0.05). ③ Tilofiban group LVEF (60 ± 8), was significantly higher than the control group (53 ± 10) (P <0.05). Conclusion The combination of tirofiban and STI in patients with STEMI can improve the postoperative coronary flow and cardiac function.