冠脉内注射替罗非班不同给药方式对急性心肌梗死介入治疗术中血流异常的影响

目的：比较急性心肌梗死介入治疗中冠脉内常规给予以及必要时给予血小板膜糖蛋白（GP）Ⅱb／Ⅲa受体拮抗剂替罗非班两种给药方式对冠脉血流异常的影响，寻找较好的替罗非班用药方式。方法：入选九四医院2005年1月至2008年10月急性心肌梗死直接PCI患者58例，随机分成常规给药组（血管开通前所有患者冠状动脉内均注射替罗非班，n=30）与必要时给药组（血管开通后即时造影显示TIMI血流≤2级者冠脉内注射替罗非班，TIMI血流3级者不给药，n=28），观察支架植入后30分钟TIMI血流、30天内主要不良心血管事件（MACE）、出血以及血小板减少情况。结果：必要给药组冠脉内给药可显著改善冠脉血流（TIMI3级给药前46．4％，给药后75％，P〈0．05），常规给药组支架植入后30分钟TIMI3级获得率高于必要给药组（96．7％比75％，P〈0．05），MACE、出血和血小板减少事件两组之间差异无统计学意义。结论：冠脉内给予替罗非班可有效降低急性心肌梗死PCI术中血流异常情况，血管开通前冠脉内常规给药方式优于必要时给药方式。

Different TIMI flow influence between general with demanded intracoronary administration of tirofiban bolus in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention

Objective： To compare of different TIMI flow influence between general with demanded intracoronary administration of tirofiban bolus in patients with acute myocardial infarction（AMI） undergoing primary percutaneous coronary intervention（PCI）. Methods： fifry-eight AMI patients ready to receive primary PCI were randomly divided into general treatment group （ intracoronary adminis- tration oftirofiban bolus immediately in all patients after coronary angiography, n=30） or demanded treatment group （intracoronary administration oftirofiban bolus only in patients of TIMI floor grade ≤2 after reperfusion,n = 28）. Changes in TIMI flow were observed 30 minutes after intracoronary stenting, Major adverse cardiovascular event （MACE）, hemorrhage event, and thrombocytopenia were observed during hospital stay; MACE was also observed 30 days after PCI. Results： The clinical characteristics and baseline angiographic findings were similar in the two groups. The incidence of TIMI floor grade 3 after stenting was more than before intracoronary administration of tirofiban in demanded treatment group（75 % vs 46.4 %, P〈0.05）, but less than general treatment group（75 % vs 96.7 %, P〈0.05）, There was no significant difference in the frequencies of MACE between the two groups （P 〉0.05）. No major hemorrhage or severe thrombocytopenia were found in the two groups during hospital stay. The total rate of bleeding was also similar in the two groups （P 〉0. 05）. Conclusion： Intracoronary tirofiban injection after coronary angiography in patients with AMI undergoing primary PCI is feasible and can reduce the rate of no-reflow or slow-reflow during operation.