不同剂量替罗非班对早期经皮冠状动脉介入术非ST段抬高型心肌梗死患者冠状动脉血流及出血风险的影响OA
Effect of Different Doses of Tirofiban on Coronary Blood Flow and Bleeding Risk in Patients with Non-ST-Segment Elevation Myocardial Infarction Undergoing Early Percutaneous Coronary Intervention
目的:探讨不同剂量替罗非班对接受早期经皮冠状动脉介入术(PCI)非ST段抬高型心肌梗死(NSTEMI)患者冠状动脉血流及出血风险的影响,为临床用药剂量优化提供依据.方法:选取2023年1月～2025年3月于某院心血管内科接受早期PCI治疗的120例NSTEMI患者作为研究对象,采用随机数字表法分为低剂量组[A组,替罗非班负荷剂量5 μg/kg、维持剂量0.075 μg/(kg·min)]、中剂量组[B组,替罗非班负荷剂量10 μg/kg、维持剂量0.1 μg/(kg·min)]、高剂量组[C组,替罗非班负荷量15 μg/kg、维持量0.125 μg/(kg·min)],每组40例.对比三组术后即刻冠状动脉血流指标[心肌梗死溶栓试验(TIMI)分级、校正 TIMI 帧数(CTFC)]、出血风险[出血学术研究联盟(BARC)分级]、术后1周峰值心肌损伤和心肌功能指标[肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、B型脑钠肽(BNP)、术后1周左心室射血分数(LVEF)]及术后30天主要不良心血管事件(MACE)发生率.结果:术后即刻,B 组和 C 组患者 TIMI 3 级率(90.00%和87.50%)高于 A 组(70.00%),CTFC 低于 A 组(P＜0.05);C 组患者 BARC 2 级及以上出血率(25.00%)高于A和B组(5.00%和7.50%,P＜0.05);B组和C组患者cTnI、CK-MB和BNP峰值低于A组,术后1周LVEF高于A组(P＜0.05);三组患者30天MACE发生率比较无统计学差异(P＞0.05).结论:中剂量和高剂量替罗非班均可以有效改善冠状动脉血流,减轻心肌损伤并提升心功能.但高剂量出血风险升高,而中剂量出血风险可控,是疗效与安全性更均衡的适宜剂量.
Objective:To investigate the effects of different doses of tirofiban on coronary blood flow and bleeding risk in patients with non-ST-segment elevation myocardial infarction(NSTEMI)undergoing early percutaneous coronary intervention(PCI),so as to provide a basis for optimization of clinical dosage.Methods:A total of 120 NSTEMI patients undergoing early PCI in the department of cardiology of a certain hospital from January 2023 to March 2025 were selected and randomly divided into low-dose group(group A,tirofiban loading dose 5 μg/kg,maintenance dose 0.075 μg/(kg·min),medium-dose group(group B,tirofiban loading dose 10 μg/kg,maintenance dose 0.1 μg/(kg·min)and high-dose group(group C,tirofiban loading dose 15 μg/kg,maintenance dose 0.125 μg/(kg·min)by random number table method,with 40 cases in each group.Immediate postoperative coronary blood flow indicators[thrombolysis in myocardial infarction(TIMI)grade,corrected TIMI frame count(CTFC)],bleeding risk[Bleeding Academic Research Consortium(BARC)grade],peak myocardial injury and heart function at 1 week after operation[cardiac troponin I(cTnI),creatine kinase isoenzyme(CK-MB),B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF)]and 30-day after major adverse cardiovascular events(MACE)incidence were compared among the three groups.Results:Immediately after operation,the TIMI 3 grade rates in groups B and C(90.00％and 87.50％)were higher than that in group A(70.00％),and CTFC was lower than that in group A(P<0.05).The BARC grade 2 or higher bleeding rate in group C(25.00％)was higher than that in groups A and B(5.0％and 7.50％,P<0.05).The peak levels of cTnI,CK-MB and BNP in groups B and C were lower than those in group A,and LVEF at 1 week after operation was higher than that in group A(P<0.05).There was no significant difference in 30-day MACE incidence among the three groups(P>0.05).Conclusion:Both medium-dose and high-dose tirofiban can effectively improve coronary blood flow,reduce myocardial injury and improve cardiac function.However,high-dose tirofiban increases bleeding risk,while medium-dose tirofiban has controllable bleeding risk,which is a suitable dose with more balanced efficacy and safety.
蒋建青;江卫萍;姚慧慧
平顶山市第二人民医院,平顶山 467000平顶山市第二人民医院,平顶山 467000平顶山市第二人民医院,平顶山 467000
医药卫生
替罗非班剂量非ST段抬高型心肌梗死早期经皮冠状动脉介入术冠状动脉血流出血风险
tirofibandosenon-ST-segment elevation myocardial infarctionearly percutaneous coronary interventioncoronary blood flowbleeding risk
《中国合理用药探索》 2026 (4)
54-59,6
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