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目的探讨急性ST段抬高心肌梗死(STEMI)患者行急诊直接经皮冠状动脉成形术(PCI)前应用不同用药剂量替罗非班(商品名为欣维宁)对梗死相关血管(IRA)及疗效的影响。方法 172例STEMI患者分为3组。A组(61例)术前只予基础用药,阿司匹林300 mg、氯吡格雷300 mg顿服。B组(56例)在术前基础用药上加用替罗非班300~400μg/h静脉滴注。C组(55例)在B组用药基础上再静脉注射替罗非班10μg/kg。对3组IRA自溶率、术中无复流、ST段回落>50%、心肌灌注分级,及住院期间临床事件(心力衰竭、大出血、死亡)进行比较分析。结果急诊冠状动脉造影发现,A、B、C组的IRA自溶率分别为31.1%、41.7%和72.7%,ST段回落>50%构成比分别为75.4%、87.5%和94.5%,3组间的差异均有统计学意义(P值均<0.05)。术中B、C组的无复流发生率有低于A组的趋势,但差异无统计学意义(P值均>0.05)。3组在住院期间的心力衰竭、严重出血并发症、病死率的差异均无统计学意义(P值均>0.05)。结论急诊PCI术前静脉滴注联合静脉注射替罗非班能显著减少STEMI患者的血栓负荷,明显升高患者IRA自溶率,减少术中无复流的发生。
Objective To investigate the effect of different dosage of tirofiban (Xinwening) on infarct-related blood vessels (IRA) and its significance before acute percutaneous transluminal coronary angioplasty (PCI) in patients with acute ST-elevation myocardial infarction Effects of the effect. Methods 172 patients with STEMI were divided into 3 groups. Group A (61 cases) preoperative only basic medication, aspirin 300 mg, clopidogrel 300 mg Dayton clothing. Group B (56 cases) were treated with tirofiban 300 ~ 400 μg / h intravenously on preoperative basis. Group C (55 cases) was given intravenous tirofiban 10μg / kg on the basis of group B medication. The three groups of IRA autolysis rate, intraoperative no-reflow, ST segment depression> 50%, myocardial perfusion and classification, and clinical events during hospitalization (heart failure, bleeding, death) were compared. Results The rates of IRA autofluorescence in groups A, B and C were respectively 31.1%, 41.7% and 72.7%, and the ratios of ST segment depression> 50% were 75.4%, 87.5% and 94.5% The differences between the two groups were statistically significant (P <0.05). No recurrence occurred in group B and group C, but the difference was not statistically significant (P> 0.05). Heart failure, severe bleeding complications and mortality in the three groups during the hospital stay were not statistically different (P> 0.05). Conclusion Preoperative intravenous infusion of tirofiban intravenous drip in emergency PCI can significantly reduce the thrombus load in patients with STEMI, significantly increase the rate of IRA autolysis, reduce the incidence of intraoperative no-reflow.