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目的:探讨急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)时冠脉内小剂量应用替罗非班对介入治疗安全性和有效性。方法:入选77例STEMI急诊介入治疗患者,全部患者入院后立即给予阿司匹林300 mg嚼服,氯吡格雷300 mg口服,随机分为替罗非班组(试药组,39例)和对照组(38例,未用替罗非班)。PCI术后梗死相关血管的心肌梗死溶栓(TIMI)血流分级、术后24 h ST段完全回落率、术后1周左心室射血分数(LVEF)、术后30 d主要心血管事件(死亡、再发心肌梗死、靶血管血运重建、反复心绞痛发作)及TIMI出血事件作为评价指标。结果:术前两组患者基线资料(年龄、性别、危险因素)差异无统计学意义。术后即刻TIMIⅢ级血流获得率试药组明显高于对照组(P<0.05)。术后24h ST段完全回落率及1周时LVEF试药组明显高于对照组(均P<0.05,P<0.01)。术后30 d随访两组主要心血管事件和主要出血事件的发生率差异均无统计学意义。结论:对急性STEMI患者急诊介入治疗时,冠脉内应用小剂量替罗非班可以获得较好的即刻造影结果,且安全、有效。
Objective: To investigate the safety and efficacy of low intracoronary administration of tirofiban for interventional therapy in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). Methods: A total of 77 STEMI patients were included in the study. All patients were given 300 mg aspirin and 300 mg clopidogrel immediately after admission. They were randomly divided into Tirofiban (39 cases) and control group (38 cases) Example, not used tirofiban). Infarction thrombolysis (TIMI) grade after PCI, complete ST drop rate at 24 h postoperatively, left ventricular ejection fraction (LVEF) at 1 week after surgery and major cardiovascular events at 30 days Death, recurrent myocardial infarction, revascularization of target vessel, recurrent angina pectoris) and TIMI bleeding as evaluation index. Results: There was no significant difference in baseline data (age, gender, risk factors) between the two groups before surgery. TIMI Ⅲ grade blood flow rate was significantly higher in the test group than that in the control group immediately after operation (P <0.05). The complete recovery rate of ST segment at 24 hours after operation and the LVEF test group at 1 week were significantly higher than those of the control group (all P <0.05, P <0.01). There was no significant difference in the incidence of major cardiovascular events and major bleeding between the two groups after 30 days of follow-up. CONCLUSIONS: Acute coronary intervention in acute STEMI patients can be performed safely and effectively with low-dose tirofiban in coronary artery.