摘要目的 比较在高危非ST段抬高性急性冠脉综合征患者中,早期和导管室内使用替罗非班介入治疗前后心肌组织水平灌注和肌钙蛋白水平.方法 138例急性非ST段抬高性急性冠脉综合征拟行冠脉介入治疗的患者,随机分为两组,分别于早期(病房内)和导管室内(造影后)静脉给予替罗非班,比较两组手术前后心肌梗死溶栓治疗临床试验心外膜血流分级(TIMI)和心肌灌注分级(TMPG)并检测肌钙蛋白Ⅰ的水平以观察心肌损伤.结果 两组患者中,介入治疗前后TIMI 3级血流无显著差异(P>0.05),心肌灌注(TMPG)3级水平介入治疗前后于早期使用替罗非班组明显优于导管室内使用组(P<0.05),术后肌钙蛋白Ⅰ水平在早期使用组明显低于导管室内使用组(P<0.05).结论 在高危非ST段抬高性急性冠脉综合征患者中,早期使用替罗非班可以改善介入治疗前后心肌灌注和减少心肌损伤.

abstractsObjective To compare the effects of upstream versus downstream tirofiban on tissure level perfu-sion and troponin Ⅰ release in high-risk non-ST-segment elevation acute coronary patients treated with percutaneous coronary intervention. Methods We randomized 138 non-ST-segment elevation acute coronary syndrome patients un-dergoing PCI to receive upstream(in the coronary care unit) and downstream(just prior to PCI) tirofiban. We com-pared the effects between the two drug regimens on tissue-level peffusion using Thrombolysis In Mycardial Infarction (TIMI) fram count,the TIMI myocardial perfusion grade(TMPG) and cardiac tropinin Ⅰ (cTn Ⅰ) release before and after PCI. Results There was no significant difference between two groups in TIMI 3 flow(P>0.05). High percent-age of TMPG 3 perfusion were observed in upstream tirofiban group than in downstream tirofiban group (P < 0.05). Post-procedual cTnI elevation was significantly less frequent among patients in the upstream group (P < 0.05). The cTnI level after PCI was significantly lower with upstream tirofiban compared with downstream tirofiban group (P<0.05). Conclusion Among high-risk non-ST-segment elevation ACS patients treated with an early invasive strategy, upstream tirofiban is associated with improved tissue-level perfusion and attenuated myocardial damage.