目的 替罗非班对急性ST段抬高型心肌梗死(STEMI)患者血小板抑制率的影响及安全性评价.方法 入选2013年3月至2014年2月间于首都医科大学附属北京安贞医院急诊危重症中心收治的STEMI患者82例,随机分为替罗非班组(42例)和对照组(40例).替罗非班组于经皮冠状动脉介入治疗(PCI)前30 min内给予盐酸替罗非班,继而持续微量泵入36 h.常规行冠状动脉(冠脉)造影,PCI只干预梗死相关血管.对照组PCI前仅给予肝素,于药物干预前后,检测血小板抑制率和活性,记录两组PCI后30 d内主要不良心血管事件(MACE)及出血情况.结果与对照组比较,替罗非班组使用替罗非班治疗24 h后血小板抑制率升高,而活性均下降,[(59.8±17.3)% vs. (80.3±8.6)%],[(58.2±7.3) mm vs. (46.9±11.5)mm],差异有统计学意义(P均＜0.05).替罗非班组PCI后30 d内MACE发生率低于对照组,9.5% vs. 20.0%,差异有统计学意义(P＜0.05).两组患者出血发生率比较,差异无统计学意义(P＞0.05).结论 替罗非班能明显升高急性ST段抬高型心肌梗死患者血小板抑制率和降低血小板活性,且不增加出血风险,安全有效.
To review the influence and safety of tirofiban on platelet inhibition rate in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Acute STEMI patients (n=82) were chosen from the Center for Emergency and Critical Medicine of Beijing Anzhen Hospital affiliated to Capital University of Medical Sciences from Mar. 2013 to Feb. 2014, and randomly divided into tirofiban group (n=42) and control group (n40). The tirofiban group was given tirofiban 30 min before PCI, and then tirofiban in micro-dose was continuously pumped for 36 h. And coronary angiography (CAG) was conducted routinely and PCI was only used for intervene infarction-related vessels in tirofiban group. The control group was given heparin before PCI. The platelet inhibition rate and platelet activity were detected before and after medicinal interventions. The major adverse cardiovascular events (MACE) and bleeding situation were recorded in 2 groups within 30 d after PCI. Results The platelet inhibition rate increased [(59.8 ±17.3)% vs. (80.3±8.6)%] and activity decreased [(58.2±7.3) mm vs. (46.9±11.5) mm] in tirofiban group compared with control group after tirofiban treatment for 24 h (P<0.05). The incidence of MACE was lower in tirofiban group than that in control group (9.5% vs. 20.0%, P<0.05), and incidence of bleeding had no statistical significance between 2 groups (P>0.05). Conclusion Tirofiban can significantly raise platelet inhibition rate and reduce platelet activity without bleeding risk in acute STEM patients, and it is safe and effective.