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目的评价直接PCI术中冠状动脉内注射血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班的安全性及其对术后患者心肌灌注、心功能的影响。方法将我院收治的101例急性心肌梗死患者随机分为替罗非班组(52例)和对照组(49例)。观察两组患者术后心肌梗死溶栓试验(TIMI)血流分级、校正TIMI计帧数、心肌灌注分级(TMPG),发病时肌酸激酶(CK)及其同工酶CK-MB峰值,出院前左室射血分数(EF)和左心室舒张末期内径(EDD),心血管事件及出血并发症。结果两组患者临床事件、出血并发症发生率间差别无统计学意义(P>0.05)。PCI术后两组患者最终造影TIMI3级血流获得率间差别无统计学意义(P>0.05);校正TIMI计帧数均值及TMPG2～3级患者所占比例间差别均有统计学意义(P<0.05)。出院前两组患者EF、EDD间差别有统计学意义(P<0.05)。发病后两组患者CK-MB峰值间差别有亦统计学意义(P<0.01)。结论直接PCI术中冠状动脉内注射替罗非班有助于改善冠脉血流和心肌灌注,保护心功能,且不增加出血并发症。
Objective To evaluate the safety of intracoronary injection of platelet glycoprotein Ⅱb / Ⅲa receptor antagonist tirofiban and its effect on postoperative myocardial perfusion and cardiac function in patients undergoing direct PCI. Methods A total of 101 acute myocardial infarction patients admitted to our hospital were randomly divided into tirofiban group (52 cases) and control group (49 cases). The TIMI flow rate, TIMI frame count, myocardial perfusion grade (TMPG), creatine kinase (CK) and its isoenzyme CK-MB peak at onset were observed after operation in both groups. Pre-left ventricular ejection fraction (EF) and left ventricular end-diastolic dimension (EDD), cardiovascular events and bleeding complications. Results There was no significant difference between the two groups in the incidence of clinical events and bleeding complications (P> 0.05). There was no significant difference in the TIMI3 grade blood flow between the two groups after PCI (P> 0.05). There was a significant difference between the corrected TIMI frame number and the proportion of TMPG2 ~ <0.05). Before discharge, the difference between EF and EDD in two groups of patients was statistically significant (P <0.05). After onset of CK-MB peak difference between the two groups were also statistically significant (P <0.01). Conclusion Intracoronary injection of tirofiban can improve coronary blood flow and myocardial perfusion, protect cardiac function without increasing bleeding complications.