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目的了解早期应用替罗非班对高危非ST段抬高急性冠脉综合症患者介入治疗术后心肌灌注及心肌损伤的影响。方法将106例高危非ST段抬高急性冠脉综合症患者随机分成2组:早期组(52例)术前6h使用替罗非班,晚期组(52例)于冠脉造影术后使用替罗非班。比较2组PCI术前、术后的TMPG分级,PCI术前测定CK-MB、cTNI,术后于12h、24h复查,观察PCI术后住院期间及1个月后心脏事件(复发心肌缺血、心肌梗死、死亡)和并发症(出血、血小板减少症)。结果与晚期组相比,早期组术前、术后心肌灌注获得TMPG2-3级比率分别为61%和76%,明显高于晚期组(分别40%和56%),差异有统计学意义(P﹤0.05);早期组PCI术后12h、24hCK-MB、cTNI升高水平低于晚期组,差异有统计学意义(P﹤0.05),两组在住院期间1个月后的心脏事件、出血、血小板减少症发生率差异无统计学意义(P﹥0.05)。结论介入治疗的高危非ST段抬高急性冠脉综合症患者在阿司匹林、氯吡格雷治疗基础上早期应用替罗非班,可明显改善PCI术后心肌灌注血流,减少PCI术后心肌损伤标志物的释放,并没有增加并发症。
Objective To investigate the effect of early tirofiban on myocardial perfusion and myocardial injury after interventional therapy in patients with high-risk non-ST-elevation acute coronary syndrome. Methods One hundred and sixty patients with high-risk non-ST segment elevation acute coronary syndrome were randomly divided into two groups: the early group (52 cases) received tirofiban at 6 hours before operation, and the late group (52 cases) after coronary angiography Luo Fei ban. The levels of TMPG before and after PCI, CK-MB and cTNI before PCI were compared between the two groups before and 12h and 24h after PCI. Cardiac events (recurrent myocardial ischemia, Myocardial infarction, death) and complications (bleeding, thrombocytopenia). Results Compared with the late group, the TMPG2-3 grade in preterm and postoperative myocardial perfusion was 61% and 76% respectively, which was significantly higher than that in the late group (40% and 56% respectively) (P < P <0.05). The levels of CK-MB and cTNI in the early PCI group were significantly lower at 12h and 24h after PCI than those in the advanced group (P <0.05). The cardiac events and bleeding in the two groups , The incidence of thrombocytopenia difference was not statistically significant (P> 0.05). Conclusion Interventional treatment of high-risk patients with non-ST-segment elevation acute coronary syndrome treated with aspirin and clopidogrel in early stage may improve myocardial perfusion and reduce myocardial injury after PCI The release of the substance did not increase the complication.