探讨急诊经皮冠状动脉介入(PCI)治疗急性心肌梗死(AMI)患者过程中应用替罗非班对急诊PCI术相关心肌再灌注损伤及近期预后的影响。

接受急诊PCI治疗的AMI患者93例，采用随机数字表法分为治疗组(n＝48)和对照组(n＝45)，治疗组于急诊PCI球囊扩张狭窄冠脉病变后立即冠脉内推注替罗非班10 μg/kg，继之以0.15 μg/(kg·min)静脉泵入36 h，对照组仅于球囊扩张成功后立即植入支架，未应用替罗非班。两组患者术前术后冠状动脉造影TIMI血流分级通过分析患者冠脉造影的图像所得；同时检测两组介入治疗术前及术后12、24 h心肌损伤标记物肌酸激酶，MB型(CK-MB)、心肌肌钙蛋白(cTnI)、内皮损伤标志物血管性血友病因子(vWF)、炎症反应标志物超敏-C反应蛋白(hs-CRP)的水平含量；并记录术后6个月再发心绞痛、心肌梗死、死亡等主要不良心脏事件(MACE)的随访情况。数据采用SPSS 19.0软件包行统计学分析，组间计量资料比较行t检验，组间计数资料比较采用χ²检验。

治疗组的TIMI 3级血流分级比例明显高于对照组，差异有统计学意义(χ²＝8.283, P＝0.004)；术前CK-MB、cTnI、hs-CRP、vWF的水平两组间比较差异无统计学意义(P均大于0.05)；两组患者术后12 h及24 h CK-MB、cTnI、vWF、hs-CRP水平均较术前增高；但与对照组比较，术后12 h治疗组患者CK-MB水平(14.34±3.12)U/L低于对照组(15.65±2.53)U/L，差异有统计学意义(t＝2.215，P＝0.029)；术后24 h治疗组患者cTnI水平(0.124±0.235)ng/mL低于对照组(0.239±0.312)ng/mL，差异有统计学意义(t＝2.016，P＝0.047)；术后12 h及术后24 h治疗组患者vWF水平(512.28±135.73)U/L、(584.63±143.38)U/L显著低于对照组(575.72±126.41) U/L、( 667.59±145.35) U/L,差异有统计学意义(t＝2.328、2.770，P＝0.022、0.007)；术后24 h治疗组患者hs-CRP水平(7.32±2.75)mg/L显著低于对照组(8.74±3.62)mg/L，差异有统计学意义(t＝2.138，P＝0.035)。治疗组与对照组比较，PCI术后6个月在因冠心病再次入院、心源性死亡及非致死性心肌梗死方面差异无统计学意义(P均大于0.05)。

AMI患者急诊PCI应用替罗非班可显著改善靶血管前向血流TIMI分级，降低PCI术后心肌损伤、内皮损伤及炎症反应，未显示出减少术后6个月MACE发生的作用。

To explore the effect of tirofiban on myocardial reperfusion injury and recent prognosis in patients with acute myocardial infarction by emergency percutaneous coronary intervention.

Ninety-three patients with acute myocardial infarction treated undergoing emergency percutaneous coronary intervention were selected and divided randomly into treatment group (n=48, 10 μg/kg bolus followed by 0.15 μg·kg^-1· min^-1 infusion 36 hours) and control group (n=45, no tirofiban). Thrombolysis in myocardial infarction flow grade was assessed from coronary angiography picture at the end of percutaneous coronary intervention. Plasma concentrations of creatine kinase, MB form, cardiac troponin I, hypersensitive C-reactive protein and von willebrand factor were measured by enzyme-linked immunosorbent assay, blood samples were obtained before and after percutaneous coronary intervention. The major adverse cardiac events of postoperative 6 months were recorded and compared between two groups of patients. SPSS 19.0 statistical software package be used to analyze the data, measurement data was compared between groups by t test, while count data was compared between groups by chi-square test.

Compared with control group, TIMI3 flow degree of treatment group in the last coronary angiography picture after percutaneous coronary intervention was higher, the difference was statistically significant (χ²=8.283, P=0.004). At 12 hours after percutaneous coronary intervention, creatine kinase, MB form of treatment group (14.34±3.12) U/L was lower than control group(15.65±2.53) U/L, the difference was statistically significant (t=2.215, P=0.029). At 24 hours after percutaneous coronary intervention, cardiac troponin I, of treatment group (0.124±0.235) ng/mL was lower than control group(0.239±0.312) ng/mL, the difference was statistically significant (t=2.016, P=0.047). At 12 and 24 hours after percutaneous coronary intervention, von willebrand factor of treatment group(512.28±135.73) U/L, (584.63±143.38) U/L was significantly lower than control group(575.72±126.41) U/L, (667.59±145.35) U/L, the difference was statistically significant (t=2.328, 2.770, P=0.022, 0.007). At 24 hours after percutaneous coronary intervention, hypersensitive C-reactive protein of treatment group (7.32±2.75) mg/L was significantly lower than control group(8.74±3.62) mg/L, the difference was statistically significant (t=2.138, P=0.035). The major adverse cardiac events (including recurrence of angina pectoris, myocardial infarction) of postoperative 6 months in treatment group was lower than control group, there was no statistically significant difference(P>0.05). Two groups had no deaths.

Tirofiban used for acute myocardial infarction patients during emergency percutaneous coronary intervention could decrease myocardial tissue perfusion injury and inflammation, but the major adverse cardiac events of postoperative 6 months were not reduced in statistics.