糖蛋白Ⅱb/Ⅲa受体拮抗剂治疗高危急性冠脉综合征的应用时限研究
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Routin upstream initiation vs deferred selective use of glycoprotein IIb/IIIa inhibitors in high-risk acute coronary syndromes
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    摘要:

    目的:探讨接受早期介入治疗的高危急性冠脉综合征(ACS)患者,血小板膜糖蛋白(GP) Ⅱb/Ⅲa受体拮抗剂的最佳应用时机-方法:选择接受早期冠脉介入治疗(PCI)的高危不稳定型心绞痛/非ST段抬高心肌梗死(UA/NSTEMI)患者162例,按替罗非班使用时机分常规早期治疗组和延期选择性治疗组,分别评估两种治疗方案对PCI术前-术后心肌组织水平灌注和30天复合心血管事件发生率的影响-结果:PCI术前TMPG分级0~1级患者共65例(40.1%),其中早期治疗组27例(32.9%),延期治疗组38例(47.5%);统计显示早期治疗组PCI术前TMPG分级0~1级发生率显著低于延期治疗组(P < 0.05)-30天复合心血管事件及出血发生率两组无差异(P > 0.05)-结论:GP Ⅱb/Ⅲa拮抗剂早期治疗能改善PCI术前心肌微循环,提高组织水平灌注-

    Abstract:

    Objective:To determine the optimal strategy for the use of glycoprotein Ⅱb/Ⅲa(Gp Ⅱb/Ⅲa) inhibitors in patients with high-risk acute coronary syndromes(ACS) receiving an early invasive treatment. Methods:One hundred and sixty-two patients with high-risk ACS undergoing early percutaneous coronary syndromes were assigned to receive either routine upstream(n = 82) or deferred selective(n =80) Gp Ⅱb/Ⅲa inhibitor treatment. The authors evaluated the effects of two strategies on tissue-level perfusion using the TIMI myocardial perfusion grade(TMPG) before and immediately after PCI. Blooding complications and the 30 day composite end point events were also evaluated. Results:Among all the total 162 patients, the TMPG 0-1 perfusion were observed in 65 patients(40.1%). The TMPG 0-1 perfusion was significantly less frequent in routine upstream treatment(n = 27) than in deferred selective group(n = 38) before PCI(32.9% vs 47.5%, respectively; P < 0.05). No differences were seen both in 30 day composite end point events and bleeding complications. Conclusion:Among high-risk ACS patients treated with an early invasive strategy, routine upstream use of Gp Ⅱb/Ⅲa inhibitors is associated with tissue-level perfusion improved and without bleeding complications increased.

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王 晖,宋 梅,薛朝阳,杨志健,朱铁兵,王连生,曹克将.糖蛋白Ⅱb/Ⅲa受体拮抗剂治疗高危急性冠脉综合征的应用时限研究[J].南京医科大学学报(自然科学版),2009,29(3):368-371

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  • 收稿日期:2008-11-19
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