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目的探讨急性前壁或下壁心肌梗死患者急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)早期联合应用替罗非班的临床疗效及安全性。方法我院2008年2月至2010年6月心内科住院治疗的急性前壁或下壁心肌梗死患者50例,随机分为替罗非班组(n=26)和对照组(n=24),替罗非班组在介入术前常规给予阿司匹林、氯吡格雷、辛伐他汀等治疗,同时静脉给予盐酸替罗非班,以输液泵持续泵入;对照组除未加盐酸替罗非班外,其他治疗同替罗非班组。观察两组术中再灌注血管终末段显影祯数和术后90 min内ST段回落情况、肌酸激酶同工酶(CK-MB)酶峰时间,术中及术后重要脏器出血情况、心衰发生率、术后1周心功能情况。结果两组靶血管PCI成功率均达100%,术中及术后出血事件、心衰、病死率无统计学差异;替罗非班组术中再灌注血管终末段显影祯数和术后90 min内ST段回落情况均优于对照组(P<0.05),术后替罗非班组CK-MB酶峰时间较对照组提前(P<0.05);1周后心脏彩超评价心脏左室射血分数(LVEF)无统计学差异。结论急性前壁或下壁心肌梗死患者急诊PCI联合应用替罗非班安全、有效,能改善冠脉微循环及心肌灌注。
Objective To investigate the clinical efficacy and safety of early combined percutaneous coronary intervention (PCI) with tirofiban in patients with acute anterior or inferior wall myocardial infarction. Methods Fifty patients with acute anterior or inferior myocardial infarction hospitalized in our department from February 2008 to June 2010 were randomly divided into two groups: tirofiban group (n = 26) and control group (n = 24) Tirofiban group routinely given aspirin, clopidogrel, simvastatin and other treatment before intervention, while intravenous infusion of tirofiban hydrochloride, continuous infusion pump; control group except without tirofiban hydrochloride, Other treatment with tirofiban group. The number of intra-arterial reperfusion vessel terminals and ST-segment drop in 90 min after operation were observed. The peak time of creatine kinase isoenzyme (CK-MB), intraoperative and postoperative bleeding of vital organs , The incidence of heart failure, cardiac function after 1 week. Results The success rate of target vessel PCI was 100% in both groups. There was no significant difference in intraoperative and postoperative bleeding, heart failure and case fatality rate. Tirofiban group intraoperative vascular reperfusion vessel number and postoperative 90 (P <0.05). The time of CK-MB enzyme peak in Tirofiban group was earlier than that of the control group (P <0.05) after 1 week. The left ventricular ejection fraction Score (LVEF) no significant difference. Conclusion Emergency PCI in patients with acute anterior or inferior wall myocardial infarction is safe and effective and can improve coronary microcirculation and myocardial perfusion.