静脉溶栓联合替罗非班治疗急性ST段抬高型心肌梗死的效果

马林业; 骆金玺; 魏琦; 高传玉

静脉溶栓联合替罗非班治疗急性ST段抬高型心肌梗死的效果

Effects of tirofiban combined with urokinase in patients with acute ST-elevation myocardial infarction

摘要

摘要: 目的: 观察急性ST段抬高型心肌梗死(STEAMI)早期尿激酶静脉溶栓联合国产替罗非班治疗的疗效及安全性。方法: 2007年6月~2008年7月收治STEAMI患者60例，均符合WHO的诊断标准且≤3 h能接受溶栓治疗并在1周内完成冠状动脉造影（CAG），分成常规组(24例)和联合组(36例)。常规组用尿激酶150万U 30 min内静脉滴入。联合组在溶栓同时应用替罗非班。两组均配合低分子肝素皮下注射，记录心电图、超声心动图、心肌酶谱、活化部分凝血酶时间(APTT)、CAG，观察间接和直接冠脉再通指标、院内心脏事件、药物不良反应，评价近期疗效和安全性。结果: 联合组在冠状动脉间接指标再通率、直接指标再通率、溶栓后胸痛缓解时间、CK-MB峰值、CK-MB达峰值时间、1周后左心室收缩末期直径(LVESD)、1周后左心室舒张末期直径(LVEDD)、平均住院天数、院内紧急血运重建、院内再发心肌梗死和常规组比较两组无统计学意义，但在心电图ST段回落≥50%、1周后梗死相关血管（IRA）血流≥TIMIⅡ级、1周后后心肌TMPⅢ级、1周后左室射血分数(LVEF)值、院内发生不稳定型心绞痛、院内心脏事件方面两组有统计学意义（P<0.05）。不良反应方面联合组溶栓24 h后凝血酶原时间延长有统计学意义（P<0.05），在血小板计数和出血事件方面两组无统计学意义。结论: ≤3 h的STEAMI在早期静脉溶栓的同时联合应用国产盐酸替罗非班在改善梗死相关血管TIMI血流和心肌灌注方面优于常规溶栓组，并未增加出血风险。

Abstract: AIM: To study the efficacy and safety of tirofiban combined with urokinase in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: Sixty consecutive STEMI patients were randomly divided into two groups: group A treated with urokinase 2 (n=24) and group B treated with tirofiban combined with urokinase (n=36). The efficacy of the treatment was compared between groups. RESULTS: Cardiovascular event rates, unstable angina, left ventricular ejection fraction and TMP in group B were better than those in group A (13.9% vs. 54.2%, 8.3% vs. 29.2%, 62.7±3.9 vs. 56.3±6.4, 72.2% vs. 41.7%, P<0.05). No significant difference was found in severe hemorrhage between groups. CONCLUSION: Tirofiban, a GPIIb/IIIa antagonist, is safe and effective when administered in combination with urokinase in STEMI patients.

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