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目的比较急性ST段抬高性心肌梗死(STEMI)患者急诊冠脉介入治疗(PCI)术前静脉应用和术中冠脉内应用替罗非班对PCI术后心肌组织灌注的影响。方法 2005年5月-2010年6月,共计116例接受急诊PCI的STEMI患者,随机分为两组:替罗非班术前静脉应用组(静脉组,n=58)和术中冠脉内应用组(冠脉组,n=58)。两组患者均在PCI前后常规给予抗血小板药物口服、肌肉注射低分子肝素。比较两组基础临床情况,术后即刻观察疗效,出血事件及应用术前术后ST段回落率、TIMI血流分级、校正的TIMI(CTFC)、2周后室壁运动记分(WMSI)等指标,比较两组疗效。结果冠脉组患者治疗后ST段完全回落率(≥70%)、TIMI血流分级(TIMI 3级快血流)、校正的TIMI帧数明显优于静脉组(P<0.05)。随访2周,两组患者WMSI、EF均改善,但冠脉组较静脉组改善更多(P<0.05)。两组术后出血并发症发生率无统计学意义。冠脉内应用替罗非班在改善冠脉介入术后心肌组织灌注水平上优于静脉内给药。结论在阿司匹林和氯比格雷、低分子肝素基础上,PCI术中冠脉内应用替罗非班较静脉内应用可更加改善STEMI患者术后即刻和术后2周心肌组织灌注疗效,而出血并发症未增加。
Objective To compare the effect of preoperative intravenous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) and intracoronary tirofiban on myocardial perfusion after PCI. Methods From May 2005 to June 2010, a total of 116 STEMI patients undergoing emergency PCI were randomly divided into two groups: Tirofiban preoperative intravenous group (vein group, n = 58) and intraoperative coronary artery Application group (coronary group, n = 58). Both groups were given antiplatelet drugs routinely before and after PCI, and intramuscular injection of low molecular weight heparin. The basic clinical conditions were compared between the two groups. Efficacy and bleeding events were observed immediately after operation. ST-segment drop, TIMI flow grade, corrected TIMI (CTFC), and WMSI , Compare the two groups curative effect. Results The complete regression rate (≥70%) of ST segment, TIMI grade III (TIMI grade 3) and corrected TIMI frames in coronary patients were significantly better than those in the control group (P <0.05). After 2 weeks of follow-up, WMSI and EF in both groups improved, but coronary artery group improved more than vein group (P <0.05). The incidence of postoperative bleeding complications in the two groups was not statistically significant. Coronary application of tirofiban was superior to intravenous administration in improving myocardial perfusion after percutaneous coronary intervention. Conclusion In the aspirin and clopidogrel, low molecular weight heparin, intracoronary administration of tirofiban for PCI can improve myocardial perfusion in STEMI patients immediately and 2 weeks after PCI, while bleeding complicated by Disease did not increase.