Effects of intracoronary and intravenous application of tirofiban on platelet aggregation rate
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摘要:
目的探讨冠状动脉与外周静脉两种途径使用替罗非班对急性冠脉综合征(ACS)患者血小板聚集率(PAR)的影响 方法72例行急诊冠状动脉支架植入术的ACS患者随机分为替罗非班冠脉内应用组(C组,n=36)和替罗非班外周静脉应用组(V组,n=36)。探讨给药后两组患者不同时间点PAR在组内的变化以及在两组间的差异,并记录两组患者出血不良事件和血小板减少症的发生情况。 结果两组患者组内给药后与给药前比较均有显著性差异(P<0.05),在冠状动脉血样中,给药后1 min C组较V组的PAR降低幅度具有统计学差异(P<0.05),但给药后5 min,两组的PAR降低趋势统计学差异消失(P>0.05);在外周静脉血样中,两组PAR的降低幅度始终相似且无统计学意义(P>0.05)。两组患者出血并发症和血小板减少症的发生率无统计学意义(P>0.05)。 结论冠状动脉内或外周静脉内应用替罗非班均能快速有效地降低冠状动脉局部及静脉内的PAR,冠状动脉途径内直接注射替罗非班后冠状动脉血样内PAR较外周静脉途径给药后冠状动脉血样内下降更明显,两组给药途径均不增加出血风险及血小板减少症等药物不良反应的发生率。 Abstract:Objective To investigate the effects of intracoronary and intravenous application of tirofiban on platelet aggregation rate(PAR) in patients with acute coronary syndrome(ACS). Methods Seventy-two patients with ACS undergoing percutaneous coronary intervention(PCI) were randomized into intracoronary tirofiban bolus group(group C, n=36)and intravenous tirofiban bolus group(group V, n=36). The changes of PAR at different time points after tirofiban application in two groups and the differences in the degree of PAR decrease between two groups were analysed, and the prevalences of bleeding and thrombocytopenia were also recorded. Results PAR decreased after treatment with tirofiban in both groups,and there were significant differences between PAR after treatment and that before treatment(P<0.05). In coronary artery, AT 1 minute after the trentment the trend of PAR decrease in group IC was more significant than that in group V(P<0.05). In peripheral vessel, there was no significant difference in the degree of PAR decrease between two groups(P>0.05). There was no significant difference in the prevalences of bleeding and thrombocytopenia between two groups(P>0.05). Conclusion Both intracoronary and intravenous application of tirofiban can effectively decrease PAR in coronary artery and peripheral vessel, and may not increase the risk of bleeding. -
表 1 患者一般临床资料比较(n=36)
冠状动脉途径 外周静脉途径 年龄/岁 内应用组 内应用组 男女比例 58.8±6.8 62.4±6.2 收缩压/mmHg* 28:8 29:7 舒张压/mmHg 140.2±16.8 138.4±19.2 空腹血糖/(mmo·L-1) 88.3±9.6 90.4±7.6 胸痛发生至实施PCI时间 5.7±0.68 5.7±0.77 相关罪犯血管 5.1±2.44 5.0±3.14 左前降支/% 58(21/36) 53(19/36) 左回旋支/% 17(6/36) 19(7/36) 右冠状动脉/% 25(9/36) 28(10/36) *1 mmHg=0.133 kPa 组间比较P>0.05 表 2 两组给药前后冠状动脉血样与静脉血样PAR比较(%)
组别 给药前 给药后1 min 给药后5 min 给药后1 h 给药后12 h 给药后24 h C组(n=36) 静脉血样 53.38±11.74 11.10±4.31① 9.88±4.12① 10.78±2.49①④ 11.02±2.12①④ 15.96±2.22①④ 冠脉血样 56.38±14.58 3.28±3.32①② 3.78±1.22①③ V组(n=36) 静脉血样 54.46±12.02 9.05±2.36① 8.84±3.76① 11.02±2.06①④ 11.22±3.02①④ 14.88±2.02①④ 冠脉血样 56.49±13.79 6.58±3.34①② 4.33±1.12①③ P<0.05为组内与给药前比较;②P<0.05为给药后1 min组间冠脉血样PAR比较;③P>0.05为给药后5 min组间冠脉血样PAR比较;④P>0.05为给药后组间1、12、24 h静脉血样中PAR比较 表 3 出血事件发生率及治疗前后血红蛋白(Hb)和血小板计数(PLT)的比较(n=36)
组别 出血不良事件n(%) Hb(g/L) PLT(109/L) 治疗前 治疗后 治疗前 治疗后 C组 3(8.33) 125.3±19.4 123.8±21.3 234.5±33.2 217.8±38.2 V组 2(5.56) 124.5±21.2 122.9±23.4 229.5±29.4 218.3±21.7 -
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