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目的:研究冠状动脉(冠脉)内注射替罗非班治疗在急性ST段抬高型心肌梗死(STEMI)病变血管再通患者急诊PCI应用中的临床疗效。方法:选取火箭军总医院2012-1-2016-01收治的STEMI患者,经冠脉造影证实病变血管再通并行急诊PCI患者191例,分为替罗非班组(108例)及对照组(83例)。替罗非班组患者在常规PCI操作基础上,给予冠脉内注射替罗非班10μg/kg。比较两组患者病变相关血管(IRA)的TIMI血流分级和手术成功率,进一步随访观察2组患者30d及12个月心血管不良事件发生率(MACE)及出血事件,并通过超声心动图评估心脏功能及结构。结果:对于IRA再通的STEMI患者,冠脉内注射替罗非班可以显著促进PCI术后IRA血流恢复,减少术后早期及晚期心力衰竭的发生,不增加出血事件,减少平均住院天数。心脏超声结果发现,冠脉内注射替罗非班显著提高患者远期心脏功能。结论:对于IRA自发再通的STEMI患者,直接冠脉内注射替罗非班能够提高心肌再灌注,增加心脏功能,改善患者预后,安全可行。
Objective: To study the clinical effect of intracoronary (coronary) injection of tirofiban in the emergency PCI of patients with recanalization of acute ST-segment elevation myocardial infarction (STEMI). Methods: Totally 191 STEMI patients admitted to Rocket Army General Hospital between January 1992 and January 2016 were enrolled in the study. One hundred and ninety-one patients undergoing PCI were enrolled in this study. The patients were divided into two groups: Tirofiban group (108 cases) and control group (83 cases) example). Patients in the tirofiban group were given intracoronary tirofiban 10 μg / kg on a routine PCI basis. TIMI flow classification and operation success rate were compared between the two groups. The incidence of cardiovascular adverse events (MACE) and bleeding events at 30 days and 12 months were further followed up and evaluated by echocardiography Cardiac function and structure. RESULTS: Intracoronary injection of tirofiban significantly improved IRA blood flow recovery after PCI in patients with STEMI with recanalization of IRA, and reduced the incidence of early and late postoperative heart failure without increasing the bleeding rate and reducing the average length of stay. Echocardiographic findings showed that intracoronary injection of tirofiban significantly improved long-term cardiac function in patients. CONCLUSIONS: Direct intracoronary injection of tirofiban improves myocardial reperfusion, increases cardiac function, and improves prognosis in STEMI patients with spontaneous recanalization of IRA and is safe and feasible.