冠状动脉内注射负荷量替罗非班对急性心肌梗死患者心肌灌注及心功能的影响

目的：探讨急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉注射负荷量盐酸替罗非班对心肌灌注及心功能的影响。方法：选择急性ST段抬高型心肌梗死患者270倒，随机分为实验组（n=133）和对照组（n=137）。所有入选患者均急诊进行经皮冠状动脉介入治疗（PCI），术中实验组患者予冠脉内注射负荷量盐酸替罗非班，对照组不予注射，主要终点为观察PCI术后即刻造影结果，同时观察术后3天、30天、360天的左室射血分数（EF），左室舒张末期内径（LVEDD）、左室收缩期末内径（LVESD）及术后360天主要心血管不良事件的发生率；次要终点为一般出血事件的发生率、血小板下降情况、血小板聚集率的变化。结果：实验组患者术后校正的TIMI帧数、术后2小时ST段回落程度、磷酸肌酸肌酶同工酶（CK-MB）峰值及峰值时间显著优于对照组（P〈0．05）．梗死相关血管无复流发生率及360天MACE的发生率显著低于对照组（P〈0．05），与对照组相比，术后30天、360天的EF值明显增加，术后30天、360天的LVEDD、LVESD显著降低（P〈0．05）；实验组术后2天血小板聚集率明显低于对照组（P〈0．05）。结论：急诊PCI术中联合冠脉内注射负荷量替罗非班可以改善心肌灌注水平及心功能，且不增加出血事件的发生率，提高远期愈后。

Intracoronary Tirofiban on the Effects of Myocardial Perfusion and Cardiac Function in the Patients with Acute ST-Segment Elevation Myocardial Infarction＊

Objective： To investigate emergency intracoronary loading dose of tirofiban hydrochloride on the effects of myocardial perfusion and Cardiac function in the patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods： 270 patients with STEMI were selected and randomly divided into experimental group （n=133） and control group （n=137）. Percutaneous coronary intervention （PCI） was emergency operated on all the patients selected, and during the operation, the experimental group was intracoronary injected loading dose of tirofiban hydrochloride, while the control group was not. The main indicators were the result of coronary arteriongraphy after PCI, and the level of EF LVEDD and LVESD on the time of 3, 30 and 360 days after the operation, as well as the rates of the main cardiovascular adverse reaction. The Secondary indicators were the incidence of general bleeding events, Platelet reduction, and the change of platelet aggregation. Results： Comparing with that in the control group, the corrected number of frames of TIMI after operation, the descending degree of ST segment, the peak value and peak time of CK-MB in experimental group were better, and the differences were statistical significance （P〈0.05）; The no-reflow incidence of infarct-related artery and the rate of MACE 360 days after operation were significantly lower than that in the control group （P〈0.05）; Comparing with that in the control group, the EF levels of 30, 360 days after operation in experimental group increased significantly （P〈0.05）, and the LWEDD and LVESD of 30, 360 days after operation decreased significantly （P〈 0.05）; The platelet aggregation of 2 days after operation was significantly lower than that in the control group （P 〈0.05）. Conclusions： Intracoronary tirofiban hydrochloride during the emergency PCI, the myocardial perfusion and heart function would be enhanced, meanwhile the incidence rate of bleeding can be reduced, and improving the long term convalescence for patients.