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目的评价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)过程中对梗死相关动脉(IRA)注射替罗非班的有效性及安全性。方法 IRA使用替罗非班组:106例STEMI住院患者在PCI术中置入支架后,经指引导管向IRA注射盐酸替罗非班500μg;静脉使用替罗非班组:106例STEMI住院患者置入支架术后24h静脉泵入盐酸替罗非班0.1μg(/kg.min)。检测两组患者PCI术前、术后24h外周血肌酸激酶同工酶(CK-MB)浓度和12导联心电图,分别记录5个导联组(分别为Ⅱ、Ⅲ、avF组,V1、V2组,V3、V4组,V5、V6组及Ⅰ、avL组)。根据时程或波幅将J波分为3个等级:小J波、大J波、巨大J波。结果 PCI术后24h,两组CK-MB峰值较术前降低,差异有统计学意义(P<0.05);IRA使用替罗非班组CK-MB峰值(52.1U/L)低于静脉使用替罗非班组(84.2U/L),差异有统计学意义(P<0.05);IRA使用替罗非班组J波个数(86)较术前(203)减少,差异有统计学意义(P<0.05);静脉使用替罗非班组J波个数(192)与术前(202)比较,差异无统计学意义(P>0.05);两组小J波比例有所增加,大J波及巨大J波比例有所下降。结论 STEMI患者PCI过程中,IRA注射替罗非班对改善冠脉再灌注有效且安全。
Objective To evaluate the efficacy and safety of injecting tirofiban for infarction-related artery (IRA) in patients with ST-elevation acute myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods IRA used tirofiban: 106 STEMI inpatients were placed in stents after PCI, 500 mg of tirofiban hydrochloride was injected into the IRA via the guiding catheter, and intravenous tirofiban was used: 106 STEMI inpatients 24h after intravenous infusion of tirofiban hydrochloride 0.1μg (/ kg.min). Peripheral blood creatine kinase (CK-MB) concentrations and 12-lead ECG were measured before and 24 h after PCI in each group. Five lead groups (group Ⅱ, Ⅲ, avF, V2 group, V3, V4 group, V5, V6 group and Ⅰ, avL group). According to the schedule or amplitude J wave is divided into three levels: small J wave, large J wave, huge J wave. Results The peak value of CK-MB in both groups was significantly lower than that before operation at 24 hours after PCI (P <0.05). The peak value of CK-MB in IRA group was lower than that of intravenous administration of tirofiban (52.1U / L) (84.2U / L), the difference was statistically significant (P <0.05). The number of J waves in IRA group using Tirofiban group (86) was lower than that of preoperative (203), the difference was statistically significant ); There was no significant difference in the number of J waves (192) between the two groups using Tirofiban intravenously (P> 0.05) The proportion has dropped. Conclusions In patients with STEMI during PCI, IRA injection of tirofiban is effective and safe for improving coronary reperfusion.