【摘要】 目的:应用ST段回落指数观察冠脉内负荷替罗非班对急性心肌梗死直接经皮冠状动脉介入治疗的有效性和安全性。方法:选择因急性ST段抬高心肌梗死入院,并接受直接急诊经皮冠状动脉介入治疗患者92名,分为试验组(冠脉内负荷替罗非班+PCI)42例和对照组(静脉负荷替罗非班+PCI)50例。观察两组术后心电图ST段回落指数,PCI术前、术后TI-MI血流情况,术后30天射血分数(EF),30天主要心血管事件(心绞痛,再次心肌梗死和死亡)。结果:试验组术后2h、4h、8h心电图ST段回落指数均高于对照组(P<0.05),两组PCI术前梗死相关血管各级TIMI血流与对照组无显著性差异。试验组PCI术后即刻达TIMI 3级血流比例高于对照组(P<0.05),PCI术后30分钟达到TIMI 3级血流比例也显著高于对照组(P<0.05),试验组30天心脏射血分数高于对照组(P<0.05),试验组30天内主要心血管事件(心绞痛+再次心肌梗死+死亡)的发生率较对照组降低66.00%(P<0.05)。两组间所有出血相关并发症无显著性差异(P>0.05)。结论:ST段回落指数能有效评价急性心肌梗死急诊经皮冠状动脉介入治疗后心肌损伤程度,是最简单易行的评估方法;冠脉内负荷替罗非班在急性心肌梗死直接经皮冠状动脉介入治疗中改善术后心肌灌注,降低心血管事件,并不增加出血的风险。更多还原

【Abstract】 Objective To observe the efficacy and the safety with intracoronary use of tirofiban therapy in acute myocardium infarction patients with ST segment elevation(STEMI) using ST segment resolution index(STRI).Methods 92 STEMI patients were randomly divided into two groups: 42 cases receiving intracoronary tirofiban therapy+PCI(experiment group) and 50 cases receiving intravenous tirofiban therapy+PCI(control group).The STRI,the TIMI flow grade before and after the operation,the ejection fraction(EF) and the primary end points(angina pectoris,re-myocardial infarction and death) of 3o days after operation were compared between two groups.Results STRI were greater in experiment group than in control group at 2h,4h,8h after PCI(P<0.05).There was no difference of TIMI flow between two groups before PCI.A greater percentage of TIMI grade 3 flow was achieved in experiment group compared with control group immediately and 30 minutes after PCI(P<0.05).The EF at 30th day after PCI was greater in experiment group than in control group(P<0.05).The frequency of primary end points during 30 days after operation was lower in experiment group compared with control group (P<0.05).There was no difference in bleeding complication between two groups.Conclusions STRI is a simplest method to assess the extent of myocardial injury in ST-segment elevated acute MI after PCI.Intracoronary use of loading dose tirofiban is effective and safe in STEMI patients,and it does not to increase the risk of bleeding.更多还原