急性前壁心肌梗死患者介入治疗早期应用替罗非班的疗效观察

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1、急性前壁心肌梗死患者介入治疗早期应用替罗非班的疗效观察作者：林忠伟,王卓，朱桂平,雷达,周万兴【摘要】目的探讨急性前壁心肌梗死患者急诊介入治疗早期联合应用替罗非班的临床疗效及安全性。方法我院2004年5月～2007年10月心内科住院治疗的急性前壁心肌梗死患者70例,年龄45～80(60.7±7.5)岁,随机分为替罗非班治疗组(n=36)和对照组(n=34),治疗组在介入术前常规给予阿司匹林、氯吡格雷、阿托伐他汀等治疗,同时静脉加用盐酸替罗非班,以输液泵持续泵入;对照组除未加盐酸替罗非班外,其他治疗同治疗组。观察两组术中

2、再灌注血管终末段显影祯数和术后90min内ST段回落情况、肌酸激酶同工酶(CKMB)酶峰时间,术中及术后重要脏器出血情况、心衰发生率、术后1周心功能情况。结果两组靶血管经皮冠状动脉介入(PCI)成功率均达100%,术中及术后出血事件、心衰、病死率差异无显著性；治疗组术中再灌注血管终末段显影祯数和术后90min内ST段回落情况均优于对照组(P<0.05)，术后治疗组CKMB酶峰时间较对照组提前(P<0.05)；1周后心脏彩超评价心脏左室射血分数(LVEF)差别无显著性。结论急性前壁心肌梗死患者急诊介入治疗

3、早期联合应用替罗非班安全、有效,能改善冠脉微循环及心肌灌注。【关键词】急性心肌梗死;经皮冠状动脉介入治疗;替罗非班8Abstract:ObjectiveToanalyzetheefficacyandsafetyoftirofibantreatmentcombinedwithemergencypercutaneouscoronaryintervention(PCI)inthepatientswithacuteanteriorwallmyocardialinfarction.Methods70patientsdiagnos

4、edwithanteriorwallmyocardialinfarctionwiththeagefrom45to80fromJuly,2004toOctober,2007inourhospitalweredividedrandomlyintotirofibantreatmentgroup(n=36)andcontrolgroup(n=34).Bothofthemwereadministeredwithaspirin,clopidogrelandatorvastatinbeforePCI,thetreatmentgrou

5、pwastreatedwithtirofibaninfusedwithinfusionpumpduringandaftertheoperation.Thetreatmentinthecontrolgroupwasthesameasthatinthetreatmentgroupexceptthatnotirofibanwasinfused.Thenumberofdevelopedframeofterminalre-perfusedvessel,loweringofSTsegment90minafterPCI,thetim

6、etopeakserumCKMBlevels,bloodingandtherateofheartfailureoneweekafterPCIwerecomparedbetweenthetwogroups.ResultsTheratesofopeningofthetargetvesselinthetwogroupswere100%.Theblooding,therateofheartfailureanddeathoccurredinbothgroupswerenotstatisticallysignificant.Th

7、enumberofdevelopedframeofterminalreperfusedvesselandlowerlevelofSTsegment90minafterPCIintirofibantreatmentgroupwere8lowerthanthoseinthecontrolgroup(P<0.05).TimetopeakserumCKMBlevelintirotibantreatmentgroupwasshorterthanthatinthecontrolgroup(P<0.05).TheLVE

8、Foftreatmentgroupwassimilartothatofthecontrolgroup(P>0.05).ConclusionTirofibantreatmentcombinedwithPCIintheelderlypatientswithacutearteriorwallmyocardialinfarction