提前肝素化和超选择冠状动脉内注入替罗非班对STEMI患者PCI的影响*

Effect of earlier heparinize and intracoronary infusion of Tirofiban on PCI in patients with acute ST segment elevated myocardial infarction*

摘要:

目的 评价提前肝素化和超选择冠状动脉内注入替罗非班对急性ST段抬高心肌梗死（STEMI）患者经皮冠脉介入术（PCI）的影响。方法 选取2016年1月—2018年12月中山大学附属第三医院粤东医院STEMI患者行急诊PCI共120例，随机将其分为对照组和观察组各60例。对照组采用常规PCI程序，观察组采用提前肝素化、直接用指引导管造影和超选择冠状动脉内注入替罗非班。比较两组靶血管TIMI血流3级的校正帧数，术后90?min的心电图ST段回落率，入院后30?min、6、12、24、36和48?h的心肌型酸酶同工酶（CK-MB）和血清心肌肌钙蛋白I（cTn?I）值和到达峰值时间，住院期间主要心脏不良事件（MACE）和严重出血事件。结果 观察组与对照组比较，TIMI校正帧数减小，ST段回落率增加，CK-MB和cTn?I的峰值降低，峰值时间提前，MACE发生率降低，差异有统计学意义（P?<0.05）。两组严重出血事件比较差异无统计学意义（P?>0.05）。结论 提前肝素化和超选择冠状动脉内注入替罗非班对STEMI患者急诊PCI可缩短缺血心肌再灌注时间，增加心肌存活，改善近期预后。

Abstract:

Objective To study effect of early heparinize and intracoronary infusion of Tirofiban on PCI treatment in patients with acute ST segment elevated myocardial infarction (STEMI). Methods A total of 120 cases with acute STEMI received PCI in the Third Affiliated Hospital of Sun Yat-Sen University-Yuedong Hospital during January 2016 to December 2018. Patients were enrolled in this study and were divided randomly into control group and observation group (n?=?60). Patients in control group received routine PCI procedure. Patients in observation group received early heparinize and intracoronary infusion of tirofiban. Corrected frames to TIMI blood flow of level 3 in target vessel, ST segment recovery rate in electrocardiogram after operation 90-min, peak value and time of CK-MB and cTnI at various timepoint (30 min, 6 h, 12 h, 24 h, 36 h and 48 h), major adverse cardiac events were recorded. Results Patients in observation group experienced significant decrease in the TIMI corrected frames, peak value and time of CK-M and cTnI (P??0.05). Conclusions Early heparinize and intracoronary infusion of Tirofiban shorten reperfusion time of ischemic myocardium, improving outcome of patients with acute STEMI.