【摘要】 目的探讨急性心肌梗死(AMI)急诊冠状动脉介入(PCI)术中应用血小板糖蛋白(glycoprotein,GP)Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班的临床价值及血清黏附分子变化。方法选择急诊入院69例AMI患者,随机分为替罗非班组(盐酸替罗非班加PCI术,32例)和对照组(PCI术,37例),均于发病12h内行急诊PCI术。收集所有病例的临床和冠状动脉造影资料,观察两组PCI术后即刻梗死相关血管(IRA)(TIMI分级)血流情况、术后30d内出血并发症、主要不良心脏事件(MACE)的发生情况及血清黏附分子变化。结果替罗非班组TIMI 3级血流为90.6%(29/32),对照组为78.3%(29/37),差异有统计学意义(P<0.05);主要不良心脏事件的发生率替罗非班组为6.25%(2/32),对照组为16.2%(6/37),差异有统计学意义(P<0.05);出血并发症发生率两组比较差异无统计学意义(P>0.05);观察住院期间替罗非班组无再梗死及死亡病例,对照组梗死及死亡发生率为6.25%(2/32),差异有统计学意义(P<0.05);血清中可溶性细胞间黏附分子-1(sICAM-1)和血管细胞黏附分子-1(sVCAM-1)水平两组比较差异有统计学意义(P<0.05)。结论在AMI急诊PCI术中应用盐酸替罗非班能改善急性心肌梗死患者PCI术后梗死相关血管的TIMI血流,减少PCI术后主要不良心脏事件的发生率,同时明显降低血清黏附分子,减少急性血栓发生率。更多还原

【Abstract】 Objective To investigate the roles of the platelet glycoprotein(glycoprotein,GP)Ⅱb/Ⅲa receptor antagonist tirofiban hydrochloride in treatement of acute myocardial infarction(AMI) with the percutaneous coronary intervention(PCI) and the changes of plasma adhesion molecules.Methods 69 emergency AMI patients were randomly divided into two groups:Tirofiban group(tirofiban hydrochloride + PCI,32 cases) and control group(PCI,37 cases).All patients were treated with PCI in 12h.Clinical and coronary artery imaging datas were collected including the blood flow of the infarct-related artery(IRA)(TIM I grade) immediately after PCI,bleeding complications within 30 days,major adverse cardiac events(MACE) and the changes of plasma adhesion molecules.Results TIMI3 blood flow in tirofiban group was 90.6%(29/32),whereas the one in control group was 78.3%(29/37)(P<0.05).The incidence of the major adverse cardiac events in tirofiban group and control group were 6.25%(2/32) and 16.2%(6/37)(P<0.05).The incidence of bleeding complications in the two groups was not significant(P>0.05).There were no infarction and death in tirofiban group during hospitalization,but the incidence of these in contron group was 6.25%(2/32)(P<0.05).The levels of plasma soluble intercellular adhesion molecule-1(sICAM-1) and vascular cell adhesion molecule-1(sVCAM-1) in the two groups were statistically significant(P<0.05).Conclusion The application of tirofiban hydrochloride in the treatment of AMI patients with the emergency PCI can improve blood flow after PCI,reduce the incidence of MACE and acute thrombosis,and significantly decrease the levels of plasma adhesion molecule.更多还原