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目的观察冠状动脉内注射替罗非班对老年急性ST段抬高型急性心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术中无复流的疗效。方法收集该院2008年1月至2011年1月老年急性STEMI行直接PCI术中出现无复流患者87例,其中替罗非班组42例,对照组45例。评估心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌组织灌注分级(TMPG)、PCI术后90 min ST段完全回落率、肌酸激酶工功酶(CK-MB)和肌钙蛋白T(cTnT)峰值、PCI术后7 d左心室射血分数(LVEF)、住院期间和PCI术后180 d内主要心脏不良事件(MACE)、住院期间出血发生率。结果替罗非班组TIMI 3级及TMPG 3级血流比例均高于对照组(分别为81.0%vs 51.1%,76.2%vs 46.7%,均P<0.01),替罗非班组ST段完全回落率大于对照组(76.2%vs 48.9%,P<0.01),CK-MB及cTnT峰值均低于对照组〔(177.1±36.2)U/L vs(221.6±44.6)U/L,(4.90±1.85)ng/L vs(6.55±2.04)ng/L,均P<0.01)〕,PCI术后7 d LVEF高于对照组(49.3%±6.3%vs 44.9%±5.2%,P<0.01);住院期间MACE少于对照组,但差异无统计学意义(33.3%vs 60.0%,P>0.05);PCI术后180 d内MACE少于对照组(40.5%vs 71.7%,P<0.01);替罗非班组与对照组均增加了患者住院期间出血发生率,分别为23.8%和11.1%,但差异无统计学意义(P>0.05)。结论冠状动脉内注射替罗非班可以增加老年急性STEMI患者直接PCI术中发生无复流现象后冠状动脉血流和心肌组织灌注,减少心肌坏死,改善心功能和预后,不增加严重出血的风险,是老年STEMI患者直接PCI术中出现无复流现象后的一种安全、有效的治疗方法。
Objective To observe the effect of intracoronary injection of tirofiban on no-reflow in elderly patients with acute ST-elevation acute myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods A total of 87 patients with no-reflow occurred in the hospital from January 2008 to January 2011 in elderly patients undergoing acute STEMI undergoing direct PCI, including 42 cases in tirofiban group and 45 cases in control group. TIMI flow classification, TIMI myocardial perfusion grading (TMPG), ST-segment complete recovery rate 90 min after PCI, CK-MB and Troponin T cTnT), left ventricular ejection fraction (LVEF) at 7 days after PCI, major adverse cardiac events (MACE) during hospitalization and 180 days after PCI, and incidence of bleeding during hospitalization. Results Tirofiban group had higher TIMI grade 3 and TMPG grade 3 blood flow ratio than control group (81.0% vs 51.1%, 76.2% vs 46.7%, all P <0.01) The peak values of CK-MB and cTnT were significantly lower than those of the control group (177.1 ± 36.2 U / L vs 221.6 ± 44.6 U / L, 4.90 ± 1.85 vs 76.2% vs 48.9%, P <0.01) (P <0.01). The LVEF of the 7th day after PCI was higher than that of the control group (49.3% ± 6.3% vs 44.9% ± 5.2%, P <0.01) MACE less than the control group, but the difference was not statistically significant (33.3% vs 60.0%, P> 0.05); MACE within 180 d after PCI less than the control group (40.5% vs 71.7%, P <0.01) Both the shift group and the control group increased the incidence of bleeding during hospitalization, which were 23.8% and 11.1% respectively, but the difference was not statistically significant (P> 0.05). Conclusion Intracoronary injection of tirofiban can increase coronary blood flow and myocardial perfusion in patients with acute STEMI after PCI without recurrence, reduce myocardial necrosis, improve cardiac function and prognosis without increasing the risk of severe bleeding , Is a safe and effective treatment for no-reflow phenomenon in elderly patients with STEMI undergoing direct PCI.