张奇,张瑞岩,胡健,杨震坤,张建盛,丁风华,朱天奇,朱政斌,张宪,黄怡琳,沈卫峰

• 1:上海交通大学医学院附属瑞金医院心脏科

摘要(Abstract)：

目的比较直接经皮冠状动脉介入治疗(PCI)前(急诊室)早期静脉负荷/维持应用和单纯术中冠状动脉(冠脉)内注射替罗非班对PCI术后即刻心肌灌注及术后30 d主要不良心脏事件(MACE)发生率的影响。方法回顾性分析707例连续性急性ST段抬高心肌梗死(STEMI)接受直接PCI患者,其中PCI时单纯冠脉内注射替罗非班(25μg/kg)86例(观察组),急诊室开始应用替罗非班[静脉负荷10μg/kg,随后0.15μg/(kg·min)静脉维持]239例(对照组)。比较两组一般临床资料、造影特征、介入治疗、术后30 d MACE及出血事件发生率。结果观察组患者年龄[(63.8±11.4)岁比(57.9±8.8)岁,P=0.01]、女性(40.7%比25.1%,P=0.006)、高血压(58.6%比51.0%,P=0.005)及多支冠脉病变(57.0%比34.3%,P<0.001)比例高于对照组。术前两组冠脉罪犯血管分布和TIMI血流相似;术后即刻,两组TIMI血流、心肌灌注分级(TMP)比较,差异均无统计学意义(P=0.66、P=0.48)。住院期间,观察组TIMI微出血发生率明显低于对照组(2.3%比9.6%,P=0.03),两组院内MACE发生率和术后30 d无MACE生存率比较,差异均无统计学意义(P=0.72、P=0.48)。结论与早期静脉负荷及维持应用替罗非班相比,急诊PCI时单纯冠脉内注射替罗非班对患者术后30 d临床预后作用相似,但院内出血事件更少。将来仍需前瞻性临床随机试验进一步验证研究结论。

关键词(KeyWords)： 心肌梗死;血管成形术;支架;替罗非班;预后

Abstract:

Keywords:

基金项目(Foundation): 上海市科委课题项目(12QA1402100)

作者(Author): 张奇,张瑞岩,胡健,杨震坤,张建盛,丁风华,朱天奇,朱政斌,张宪,黄怡琳,沈卫峰

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