摘要
目的在常规抗凝、抗血小板基础上,观察国产血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班在行冠状动脉介入治疗术(PCI)前后对急性冠状动脉(冠脉)综合征的疗效和安全性。方法符合急性冠脉综合征(不稳定型心绞痛/非Q波心肌梗死)入选标准患者56例,随机分为治疗组(替罗非班,n=28)和对照组(n=28),在均使用阿司匹林、氯吡格雷和低分子肝素的基础上,治疗组给予替罗非班(负荷量10μg/kg,在3min内推注),继以0.15μg/(kg.min)由微量泵持续泵入24～36h;对照组病例直接进行经皮冠状动脉介入治疗(PCI)。结果治疗组30d内主要不良心脏事件(包括顽固性心绞痛/新发心肌梗死/死亡)发生率较对照组显著降低(10.7%比21.4%,P<0.05)。围术期出血并发症较对照组稍高,但差异无统计学意义。两组术后血小板计数、心功能(射血分数值)差异无统计学意义。结论替罗非班在急性冠脉综合征标准治疗基础上能进一步减少心肌缺血事件发生率,改善心肌缺血,安全性好,但其长期疗效及毒副作用有待进一步观察。
Objective To investigate the efficacy and safety of tirofiban in the treatment of acute coronary syndrome （ACS） patients during primary PCI. Methods Sixty-two patients with ACS who underwent primary percutaneous coronary intervention（PCI） were randomly divided into two groups：the tirofiban ＋ PCI group （n = 28） and the primary PCI group （n = 28）. Tirofiban was predominantly initiated in the catheter laboratory before or during the intervention and maintained for a mean of 24 ～ 36 hours on a background of aspirin, clopidogrel and low molecular weight heparin therap （ 10 μg/kg for bolus, followed by 0.15μg/（ kg · min） infusion）. Platelet counting,MACE event and perip rocedural complication were investiga- ted. Heart function by echo was observed. Results The incidence of the major primary end point （ refractory ischemia, new myocardial infarction and death） at 30 days was significantly lower in the tirofiban group than that in the placebo group （ 10.7% vs 21.4% ,P 〈0.05）. There were no major bleeding events happened. There was no statistical significance in platelet counting and EF value between the two groups. Both groups showed no thrombocytopenia. Conelusiolas Tirofiban may further lower the incidence of ischemic events in patients with acute coronary syndrome on the basis of standard treatments in ACS, however its long-term efficacy and side effects require further investigation.
出处
《微创医学》
2008年第4期320-322,共3页
Journal of Minimally Invasive Medicine
关键词
冠状动脉综合征
替罗非班
介入治疗
Acute coronary syndrome
Tirofiban
pereutaneous coronary intervention
