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目的观察不同剂量替罗非班联合经皮冠状动脉介入术(PCI)治疗非ST段抬高型急性冠脉综合征(NSTE-ACS)的临床疗效。方法选取2014年1月—2016年1月南通市第一人民医院收治的NSTE-ACS患者96例,采用随机数字表法分为对照组和观察组,每组48例。两组患者均接受常规抗凝抗拴治疗及PCI,对照组患者在此基础上给予全量替罗非班(起始推注量为10μg/kg,之后0.15μg·kg-1·min-1静脉泵注,持续24 h),而观察组患者在此基础上给予半量替罗非班(起始推注量为5μg/kg,之后0.075μg·kg-1·min-1静脉泵注,持续24 h)。比较两组患者治疗前后心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)及并发症情况。结果两组患者治疗前后TIMI血流分级比较,差异均无统计学意义(P>0.05);两组患者治疗后TIMI血流分级为2~3级者所占比例均高于治疗前(P<0.05)。两组患者治疗前后TMPG比较,差异均无统计学意义(P>0.05);两组患者治疗后TMPG为2~3级者所占比例高于治疗前(P<0.05)。两组患者均未出现血小板减少症。两组患者主要不良心血管事件(MACE)发生率比较,差异无统计学意义(P>0.05);观察组患者轻度出血率低于对照组(P<0.05)。结论全量或半量替罗非班联合PCI术均能有效改善NSTE-ACS患者冠在状动脉血流及心肌灌注,但半量替罗非班较为安全。
Objective To observe the clinical efficacy of different doses of tirofiban in combination with percutaneous coronary intervention (PCI) in the treatment of non-ST segment elevation acute coronary syndrome (NSTE-ACS). Methods 96 patients with NSTE-ACS admitted to Nantong First People’s Hospital from January 2014 to January 2016 were randomly divided into control group and observation group with 48 cases in each group. Patients in both groups received conventional anticoagulant anti-tethering therapy and PCI. Patients in the control group received a full dose of tirofiban (initial bolus injection of 10 μg / kg, followed by 0.15 μg · kg -1 · min -1 intravenous (24 h), while patients in observation group were given half dose of tirofiban (initial injection volume was 5 μg / kg, followed by 0.075 μg · kg -1 · min -1 intravenously for 24 h). The TIMI flow classification, TIMI myocardial perfusion grading (TMPG) and complications were compared between the two groups before and after treatment. Results There was no significant difference in TIMI flow grade between the two groups before and after treatment (P> 0.05). The TIMI flow grade was higher in both groups after treatment than those before treatment (P < 0.05). There was no significant difference in TMPG between the two groups before and after treatment (P> 0.05). The proportion of TMPG 2 ~ 3 after treatment in both groups was higher than that before treatment (P <0.05). No thrombocytopenia occurred in either group. There was no significant difference in the incidence of major adverse cardiovascular events between the two groups (P> 0.05). Mild bleeding rate in the observation group was lower than that in the control group (P <0.05). Conclusion All or half of tirofiban combined with PCI can effectively improve coronary artery blood flow and myocardial perfusion in patients with NSTE-ACS, but it is safe to use half dose of tirofiban.