不同剂量替罗非班联合替格瑞洛对糖尿病STEMI患者急诊PCI的疗效观察

Therapeutic Effect of Different Doses of Tirofiban Combined with Ticagrelor on Emergency PCI in Patients with Diabetic STEMI

关键词:  糖尿病  急性心肌梗死  急诊经皮冠状动脉介入治疗  抗血小板  并发症  出血

Key words:  diabetes  acute myocardial infarction  emergency percutaneous coronary intervention  antiplatelet  complications  bleeding

摘要:

目的 探讨双联抗血小板（阿司匹林加替格瑞洛，DAPT）联合不同剂量的替罗非班对糖尿病合并急性心肌梗死（ST-segment elevation myocardial infarction，STEMI）急诊经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）的近期疗效和安全性。方法 接受急诊PCI的糖尿病合并STEMI患者158例，随机分为DAPT组（A组）53例，DAPT加常规剂量替罗非班组（B组）52例，DAPT加1/2剂量替罗非班组（C组）53例；PCI时B、C组冠状动脉内注射盐酸替罗非班（10 μg·kg^-1），PCI后B组以0.15 μg·kg^-1·min^-1、C组以0.075 μg·kg^-1·min^-1持续静脉泵入24 h；统计分析3组的临床资料、冠状动脉病变特征、住院时间和并发症的发生率。结果 与A组比较，PCI术后B组和C组TIMI 3级血流和TMPG 3级心肌灌注明显升高（P<0.05）；住院期间再梗死、梗死后心绞痛、严重心律失常、Killip Ⅲ级以上心功能的发生率显著降低（P<0.05）。B组严重出血、中度出血的发生率显著高于A组和C组患者（P<0.05），B组和C组轻度出血的发生率显著高于A组（P<0.05）。结论 糖尿病合并STEMI急诊PCI时1/2剂量的替罗非班加DAPT能够有效改善TIMI血流和TMPG心肌组织水平灌注，降低梗死后心绞痛、再梗死、严重心律失常、心力衰竭等严重并发症的发生，减少严重出血的并发症。

Abstract:

OBJECTIVE To investigate the efficacy and safety of dual antiplatelet treatment(aspirin+ticagrelor, DAPT) combined with different doses of tirofiban on diabetic patients with ST-segment elevation myocardial infarction(STEMI) receiving emergency percutaneous coronary intervention(PCI). METHODS One hundred fifty eight diabetic patients with STEMI undergone emergency PCI were randomly divided into three groups:53 patients in the DAPT group(group A), 52 patients with DAPT plus conventional doses of tirofiban group(group B), and 53 patients with DAPT plus one-half dose of tirofiban group(group C). In PCI, group B and C were injected intracoronally with tirofiban hydrochloride(10 μg·kg^-1). After PCI, group B was 0.15 μg·kg^-1·min^-1, group C was 0.075 μg·kg^-1·min^-1 continuous intravenous infusion for 24 h. Statistical analysis of the clinical data, coronary artery lesion characteristics, length of hospital stay and complications. RESULTS Compared with group A, thrombolysis in myocardial infarction 3(TIMI 3) blood flow and TIMI myocardial perfusion grade 3(TMPG 3) myocardial perfusion of patients in group B and group C after PCI was significantly higher(P<0.05), reinfarction during hospitalization, post-infarction angina, severe arrhythmia, the incidence of cardiac function above Killip Ⅲ level of patients in group B and group C after PCI was significantly lower(P<0.05). Severe bleeding and moderate incidence of bleeding in group B was significantly higher than that in group A and group C(P<0.05). Minor bleeding incidence of group B and group C was significantly higher than that of group A(P<0.05). CONCLUSION Emergency PCI for diabetes mellitus complicated with STEMI, one-half dose of tirofiba plus DAPT can effectively improve TIMI blood flow and TMPG myocardial tissue perfusion, reduce the occurrence of severe complications such as angina pectoris, re-infarction, severe arrhythmia and heart failure after infarction, and reduce the complications of severe hemorrhage.