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目的探讨不同剂量替罗非班在急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入术(PCI)中的疗效及安全性。方法将2013年3月至2015年6月收治的急性STEMI患者随机分为A(n=49)、B(n=49)和C(n=48)3组,PCI术中冠脉内给予不同剂量替罗非班;A、B和C组替罗非班剂量分别为5μg/kg、10μg/kg和20μg/kg,随后A组(0.075μg·kg-1·min-1)、B组(0.15μg·kg-1·min-1)、C组(0.15μg·kg-1·min-1)均持续静脉泵入替罗非班至PCI术后48 h。统计3组住院期间及术后1个月的左心射血分数(LVEF)、出血例数,冠状动脉血流分级、ST段抬高总和回落百分比(sum STR)情况、NT-pro BNP的变化(分别检测术前和术后第14天的值)、主要心脏不良事件;比较3组术前5 min和术后12 h的血小板计数(PLT)、血小板集聚率(PAR)、血小板平均体积(MPV)、血小板压积(PCT)、血小板分布宽度(PDW)、缺氧诱导因子-1α(HIF-1α)、诱生型一氧化氮合酶(i NOS)、高敏C反应蛋白(hs-CRP)的异同。采用多变量重复测量方差分析及两两比较的q检验和R×C表χ2检验及其分割法(用χ2检验分割法时,取α’=0.017为检验水准)进行统计学分析。结果与A组相比,C组术后1个月左心室射血分数(LVEF)、TIMI3级比例、sum STR≥50%比例、出血率均明显增高,而14 d N-末端B型利钠肽前体(NT-pro BNP)、PAR、MPV、PDW、HIF-1α均明显降低(P<0.05或P<0.017);术后与A组相比,B组的MPV、PDW、HIF-1α均明显降低(P均<0.05);术后与B组相比,C组14 d的NT-pro BNP、PAR均明显降低(P均<0.05),其他指标的差异均不明显(P>0.017或P>0.05)。结论 3种剂量的替罗非班均有一定疗效,使用替罗非班应个体化。替罗非班剂量加大后,其出血几率也会增高,因此一般情况下常规剂量替罗非班应是合适的选择。
Objective To investigate the efficacy and safety of different doses of tirofiban in emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Acute STEMI patients who were treated from March 2013 to June 2015 were randomly divided into three groups: A (n = 49), B (n = 49) and C (n = 48) The doses of tirofiban in group A, B and C were 5μg / kg, 10μg / kg and 20μg / kg respectively in groups A, B and C, and then in group A (0.075μg · kg -1 · min -1) 0.15μg · kg-1 · min-1), and C group (0.15μg · kg-1 · min-1) were intravenously injected with tirofiban 48 h after PCI. The left ventricular ejection fraction (LVEF), the number of hemorrhage cases, coronary blood flow classification, the sum STR fall percentage (sum STR) and the changes of NT-pro BNP in the three groups during hospitalization and one month after operation (Preoperative and postoperative day 14, respectively) and major adverse cardiac events. The PLT, PAR, and platelet mean volume (PLT) were compared between the 5 groups before operation and 12 h after operation MPV, PCT, PDW, HIF-1α, iNOS, hs-CRP ) Similarities and differences. Multivariate repeated measures ANOVA and pairwise comparisons of q test and R × C table χ2 test and its segmentation (using χ2 test segmentation method, taking α ’= 0.017 as the test level) were statistically analyzed. Results Compared with group A, left ventricular ejection fraction (LVEF), ratio of TIMI grade 3, sum STR≥50% and bleeding rate were significantly increased in group C at 1 month after operation, while the level of N-terminal B-type natriuretic peptide The levels of MPV, PDW and HIF-1α in group B were significantly lower than those in group A after operation (P <0.05 or P <0.017) (P <0.05). Compared with group B, the BNP and PAR of NT-pro in group C on the 14th day after operation were significantly lower (all P <0.05), while the other indexes were not significantly different (P> 0.017 Or P> 0.05). Conclusion Tirofiban at all three doses had some efficacy and should be individualized with tirofiban. Tirofiban dose increases, the risk of bleeding will increase, so under normal circumstances the conventional dose of tirofiban should be the appropriate choice.