国产替罗非班对急性冠脉综合征行PCI术患者的临床疗效分析
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摘要
目的对急性冠脉综合征行PCI术的患者,在抗血小板抗凝治疗基础上加用国产替罗非班(商品名欣维宁),观察疗效并行安全性评价,尤其对替罗非班使用剂量作初步探讨。方法选择2006年1月—2007年6月30日入院并明确诊断为急性冠脉综合征的患者,符合入选条件的127例,根据术后替罗非班使用剂量,按照自愿原则分为全量组(替罗非班以0.1ug/kg·min维持静脉点滴)和半量组(替罗非班以0.05ug/kg·min维持静脉点滴),所有患者均正规使用肝素(包括低分子肝素)、盐酸氯吡格雷、阿司匹林。观察临床特征,PCI术情况,终点事件为住院期间主要心血管事件(MACE)。结果两组临床基线基本相似,没有统计学差异。PCI术中病变数,其中三支病变数全量组占40.26%,半量组占44.00%;双支病变全量组占37.66%,半量组占30.00%;单支病变全量组占22.08%,半量组占26.00%,两组比较P>0.05,没有统计学差异。住院期间MACE,非致命性心梗全量组3.90%(3例),半量组4.00%(2例);死亡全量组1.3%(1例),半量组2.00%(1例);总MACE发生率,全量组33.77%(26例),半量组34.00%(17例),两组之间没有统计学差异。结论国产替罗非班对接受经皮冠状动脉介入治疗(PCI)术后急性冠脉综合征的患者是安全有效的,使用半量不会增加心血管事件的发生率。
Objective To investigate the values and safety in especial dose of china-made Tirofiban in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI). Methods One hundred twenty-seven patients suffered from acute coronary syndromes between January 2006 and June 2007 were selected and divided into two groups according to dose(full dose and semis).These patients who had treated with heparins(including low molecular weight heparins), clopidogrel sulfate and aspirin were observed on clinical characteristics,PCI outcomes, The composite end point events consisted of the major cardiovascular events(MASE) during the hospital days. Results The clinical characteristics were similar for two group(P>0.05).PCI outcomes showed that three artery stenosis was 40.26% in full dose group, 44% in semis group; two coronary artery stenosis was 37.66% in full dose group, 30% in semis group; single artery stenosis was 22.08% in full dose group, 26% in semis group, no statistical significant difference observed. the incidence proportion of MACE during hospitalization, non-fatal myocardial infarction, the full dose group was 3.90% (3 cases), 4.00% in semis group (2 cases); Death in full dose group was 1.30% (1 case), 2.00% in semis group (1 case). The total rate of MACE was 33.77% in full dose group (26 case), 34.00% in semis group (17 case). There was no statistical significant diffeence between the two groups. Conclusion The results suggest that Tirofiban is a safe and tolerable therapy drug for ACS patients to PCI,To have the dose halved will not increase incidence rate of heart-blood vessel event.
Objective To investigate the values and safety in especial dose of china-made Tirofiban in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI). Methods One hundred twenty-seven patients suffered from acute coronary syndromes between January 2006 and June 2007 were selected and divided into two groups according to dose(full dose and semis).These patients who had treated with heparins(including low molecular weight heparins), clopidogrel sulfate and aspirin were observed on clinical characteristics,PCI outcomes, The composite end point events consisted of the major cardiovascular events(MASE) during the hospital days. Results The clinical characteristics were similar for two group(P>0.05).PCI outcomes showed that three artery stenosis was 40.26% in full dose group, 44% in semis group; two coronary artery stenosis was 37.66% in full dose group, 30% in semis group; single artery stenosis was 22.08% in full dose group, 26% in semis group, no statistical significant difference observed. the incidence proportion of MACE during hospitalization, non-fatal myocardial infarction, the full dose group was 3.90% (3 cases), 4.00% in semis group (2 cases); Death in full dose group was 1.30% (1 case), 2.00% in semis group (1 case). The total rate of MACE was 33.77% in full dose group (26 case), 34.00% in semis group (17 case). There was no statistical significant diffeence between the two groups. Conclusion The results suggest that Tirofiban is a safe and tolerable therapy drug for ACS patients to PCI,To have the dose halved will not increase incidence rate of heart-blood vessel event.
引文
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[3]陈步星,卢明瑜,刘如辉等.急性冠脉综合征的处置:无持续性ST段抬高的急性冠脉综合征[J]:中国医药导刊, 2001, 3(2): 82-96
[4] Storrow AB, Gibler WB. Chest pain centers:diagnosis of acute coronary syndromes [J]. Ann Emerg Med, 2000,35:44-961
[5]杨跃进,华伟.急性冠脉综合征[M]阜外心血管内科手册.北京:人民卫生出版社, 2006, 8, 105-110
[6]胡大一,马长生.急性冠脉综合征与炎症性生物标志物[M]心脏病学实践2006.北京:人民卫生出版社,2006, 168
[7] de Vreede JJ, Gorgels AP, Verstraaten GM, et al. Did prognosis after acute myocardial infarction change during the past 30 years? A meta-analysis. [J] J Am Coll Cardiol. 1991,18:698-706
[8] Hasai D, Begar S, Wallentin L, et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin. The Euro Heart Survey of Acute Coronary Syndromes ( Euro Heart Survey ACS ) .[J] Eur Heart J . 2002,15:1190-1201
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[10] Frink RJ, Chronic ulcerated plaque: New insights into the pathogenesis of acute coronary disease [J]. J Invas Cardiol, 1994, 6: 173-1854
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[12]许青,李静,郑艳彬.新型抗血小板药物—血小板糖蛋白IIb/IIIa受体拮抗药[J].中国新药与临床杂志, 2002,3:47-52
[13]秦华,梁先明.新型血小板GpIIb/IIIa受体拮抗剂盐酸替罗非班.中国新药杂志, 2002,11:197
[14] Platelet Receptor Inhibition in Ischemic Syndrome Management(PRISM) Study Investigators. A comparison of aspirin plus tirofiban with aspirin plus heparin forunstable angina. N Engl J Med, 1998,338:1498-1505
[15] The PRISM-PLUS Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med,1998,338:1488-1497
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