【摘要】 目的:观察和分析替罗非班联合大剂量他汀治疗急性心肌梗死(AMI)的疗效及安全性,评价其对心肌灌注及心脏功能的影响。方法:2011年5月至2013年1月就诊时超出急诊PCI时间窗(≥12h),且胸痛缓解或无加重的AMI患者共97例,均持续泵入替罗非班48h,根据联合瑞舒伐他汀的剂量分为大剂量组(52例,20mg,1次/d口服,持续服药至梗塞后1月,改为常规剂量10mg,1次/d)和常规剂量组(45例,10mg,1次/d口服)。全部患者经过保守治疗后于7~10d行择期PCI治疗,比较两组间心肌灌注水平、术后1周和梗塞后30d心脏功能,酶学改变[肌酸磷酸激酶(CK),乳酸脱氢酶(LDH)]及住院期间主要不良心血管事件(MACE)。结果:与常规剂量组比较,大剂量组梗死相关血管内血栓积分[(1.32±1.01)分比(0.81±0.78)分]、校正的TIMI帧数[(32.4±4.73)帧比(26.8±2.34)帧]显著减少(P=0.021,P<0.001);择期PCI术后大剂量组心肌梗死溶栓试验(TIMI)血流明显优于常规剂量组(P=0.024)。大剂量组术后1周左室射血分数(LVEF)明显高于常规剂量组[(51.4±8.9)%比(47.7±8.7)%,P=0.021];术后7d及30d,两组CK、LDH水平均无明显差异(P>0.05)。术后住院期间和30d两组患者均未出现MACE。结论:替罗非班联合大剂量他汀治疗急性心肌梗死安全、有效,能降低冠脉内的血栓负荷,改善心肌组织灌注和心脏功能,而不增加主要不良心血管事件。更多还原

【Abstract】 Objective:To observe and analyze the therapeutic effect and safety of tirofiban combined large dose statin in patients with acute myocardial infarction(AMI),and evaluate its influence on myocardial perfusion and cardiac function.Methods:A total of 97 consecutive AMI patients visited to our hospital from May 2011 to January 2013,who were beyond the emergency PCI time window(≥12h),their chest pain was remissive or not further aggravated were studied.All patients were pumped with tirofiban for 48hcontinuously;according to combined rosuvastatin dose,they were divided into large dose group(n=52,20 mg,once/d,until one month after infarction,then changed to routine dose of 10 mg,once/d)and routine dose group(n=45,10 mg,once/d).All patients received selective PCI after 7~10dconservative treatment.Myocardial perfusion level,left ventricular ejection fraction(LVEF)on one week after PCI and 30 dafter AMI,enzymology changes[creatine(CK),lactate dehydrogenase(LDH)]and major adverse cardiovascular events(MACE)during hospitalization were compared between two groups.Results:Compared with routine dose group,there were significant reductions in thrombus scores in infarct related artery(IRA)[(1.32±1.01)scores vs.(0.81±0.78)scores]and corrected TIMI frame[(32.4±4.73)vs.(26.8±2.34)]in large dose group(P=0.021,P<0.001);after selective PCI,TIMI flow of large dose group was significantly better than that of routine dose group(P=0.024).On one week after PCI,LVEF:(51.4±8.9)%of large dose group was significantly higher than that of routine dose group(47.7±8.7)%,P=0.021;there were no significant difference in levels of CK and LDH between two groups on 7dand 30 dafter PCI(P>0.05).There was no MACE in both groups during hospitalization and 30 dafter PCI.Conclusion:Tirofiban combined large dose statin is safe and effective in patients with acute myocardial infarction,it can reduce intra-coronary thrombus burden,improve myocardial tissue perfusion and cardiac function without increasing MACE.更多还原