沈杰,张奇,张瑞岩,张建盛,杨震坤,胡健,郑爱芳,张宪,沈卫峰

• 1:上海交通大学医学院附属瑞金医院心内科
• 2:上海交通大学医学院附属瑞金医院心内科

摘要(Abstract)：

目的前瞻性比较急诊室或导管室应用替罗非班对急诊冠状动脉介入治疗(PCI)急性ST段抬高型心肌梗死(STEMI)临床疗效的影响。方法入选连续113例接受急诊PCI治疗的急性STEMI患者,随机分为急诊室内(术前使用组,56例)和导管室内替罗非班使用组(术中使用组,57例)。比较两组基础临床情况、介入治疗结果、术后30天和180天主要心脏不良事件(MACE,死亡/再梗死/再次靶血管重建)发生率及左室射血分数(LVEF)。结果两组基础临床情况差异无统计学意义。与术中使用组相比,术前使用组急诊PCI术前梗死相关动脉TIMI3级复流血流发生率明显增高(23.2%比8.8%,P<0.05)。术后校正TIMI帧数(cTFC)显著降低(20.2±4.7帧比23.1±5.3帧,P<0.01),但TIMI3级(96.4%比94.7%,P>0.05)、TMP3级(64.3%比57.9%,P>0.05)、ST段总和回落(6.2±1.2mm比6.0±1.1mm,P>0.05)、肌酸激酶混合型同工酶(CK-MB)峰值(229.5±97.1ng/mL比247.9±78.8ng/mL,P>0.05)、肌钙蛋白(Tn)I峰值(67.7±31.0ng/mL比74.6±32.8ng/mL,P>0.05)、平均住院天数(12.7±6.2d比12.0±4.5d,P>0.05)差异均无统计学意义。术后30天和180天术前使用组MACE发生率分别降低49%和32%、左室射血分数分别增加4.3%和3.6%(P均>0.05)。Kaplan-Meier生存分析显示,两组术后30天(96.4%比93%,P>0.05)和180天(92.9%比89.5%,P>0.05)无MACE生存率差异无统计学意义。术前使用组出血并发症发生率低于术中使用组(10.7%比12.3%,P>0.05)。结论急诊室内早期应用替罗非班能显著提高急性STEMI患者急诊PCI术前梗死相关动脉开通率和术后心肌灌注,但近期临床预后与导管室内使用该药组的差异无统计学意义。

关键词(KeyWords)： 心肌梗死;替罗非班;血管成形术,经腔,经皮冠状动脉;预后

Abstract:

Keywords:

基金项目(Foundation): 上海市科学技术委员会科研基金资助(编号:05DZ19503)

作者(Author): 沈杰,张奇,张瑞岩,张建盛,杨震坤,胡健,郑爱芳,张宪,沈卫峰

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