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目的:探讨半量替罗非班在急性ST段抬高心肌梗死(STEMI)患者行急诊冠状动脉介入治疗(PCI)术后应用的疗效和安全性。方法:入选2014年1月至10月因STEMI就诊,并行急诊PCI治疗患者共120例。于术前采用随机数字法将患者分为标准剂量组(A组,60例)和半量组(B组,60例)。术前常规服用阿司匹林300mg、氯吡格雷600mg,推注肝素70IU/kg,术中应用替罗非班10μg/kg,对于血栓负荷重的患者,应用机械抽吸装置,保证术后心肌梗死溶栓治疗血流分级(TIMI)3级血流。术后两组均联合给予低分子肝素皮下注射,比较两组患者的基线资料、术后90min ST段回落不良率、肌酸激酶同工酶(CK-MB)及肌钙蛋白I峰值、左心室射血分数、主要不良心血管事件(靶血管重建、再次心肌梗死、支架内血栓、心力衰竭、死亡)和出血事件。结果:两组患者的基线资料差异无统计学意义(P>0.05)。术后90min ST段回落百分比(sumSTR)、肌酸激酶同工酶及肌钙蛋白I峰值、左心室射血分数及主要不良心血管事件差异均无统计学意义(P>0.05),标准剂量组术后发生主要出血1例,小出血1例,轻微出血5例(鼻出血2例,牙龈出血2例,痔疮出血1例),半量组术后发生轻微出血1例为牙龈出血,术后出血的差异有显著统计学意义(P=0.03)。结论:急诊PCI术后TIMI血流3级的STEMI患者半量应用替罗非班可以安全有效降低心血管事件,且有助于减少出血并发症。
Objective: To investigate the efficacy and safety of half-dose tirofiban in the treatment of patients with acute ST-elevation myocardial infarction (STEMI) undergoing emergency coronary intervention (PCI). METHODS: A total of 120 patients enrolled for STEMI and concurrent emergency PCI from January to October 2014 were enrolled. Patients were divided into standard dose group (A group, 60 cases) and semi-dose group (B group, 60 cases) by random number method before operation. Preoperative routine use of aspirin 300mg, clopidogrel 600mg, heparin 70IU / kg bolus, intraoperative tirofiban 10μg / kg, for patients with thrombotic load, the application of mechanical suction device to ensure postoperative myocardial infarction thrombolysis Treatment of grade 3 (TIMI) blood flow. Postoperative two groups were given low molecular weight heparin subcutaneously. Baseline data of two groups were compared. The postoperative 90-day ST-segment failure rate, CK-MB and troponin I peak, left ventricular Ejection fraction, major adverse cardiovascular events (target revascularization, recurrent myocardial infarction, stent thrombosis, heart failure, death) and bleeding events. Results: There was no significant difference in baseline data between the two groups (P> 0.05). There was no significant difference in STO-ST segment percentage (sumSTR), creatine kinase isoenzyme and troponin I peak, left ventricular ejection fraction and major adverse cardiovascular event 90 min after operation (P> 0.05) Postoperative bleeding occurred in 1 case, 1 case of small bleeding, 5 cases of mild bleeding (2 cases of nasal bleeding, 2 cases of bleeding gums, 1 case of bleeding hemorrhoids), 1 case of minor bleeding after bleeding in the semi-dose group was bleeding gums, postoperative bleeding The difference was statistically significant (P = 0.03). CONCLUSIONS: Tirofiban can be used safely and effectively to reduce cardiovascular events in STEMI patients with grade 3 TIMI flow after emergency PCI and to help reduce bleeding complications.