?作者:张孝忠(解放*医院)王红(解放*医院)张晋(解放*医院)
盐酸替罗非班；急性冠脉综合征；冠脉介入治疗；临床疗效
目的观察小剂量国产替罗非班在急性冠脉综合征（ACS）介入治疗中应用的疗效及安全性。方法共入选例ACS患者，其中男90例，女72例，均符合冠脉介入治疗适应证并成功进行了冠脉血运重建。将入选患者随机分为两组，A组80例，术前30min或术中立即按说明书提供的剂量减半（0.2μg·kg-1·min-1）静脉滴注应用国产盐酸替罗非班，30min后改为0.05μg·kg-1·min-1，连续静脉滴注24~48h；B组82例，术后回到病房即刻应用盐酸替罗非班，剂量及方法同A组。两组术后肝素或低分子肝素减为半量，阿司匹林及氯吡格雷按ACS的常规剂量使用。观察用药后30天内任何原因的死亡、新的心肌梗死及顽固性心绞痛的发生情况。结果A组30天内因急性泵功能衰竭死亡1例（1.25％），无新的心肌梗死及顽固性心绞痛发生；B组30天内出现顽固性心绞痛1例（1.22％），无死亡及新发心肌梗死；A、B两组间无统计学差异（X2=0.19，P＜0.05）。A组发生轻中度出血4例（5.00％），无严重出血发生；B组发生轻中度出血3例（3.66％），无严重出血发生；A、B两组间无统计学差异（X2=0.，P＜0.05）。A组血小板聚集率从(63.5±17.4)％降为用药后的(31.7±13.5)％，差异有统计学意义（t=6.28，P＞0.05）；B组血小板聚集率从(64.1±18.2)％降为用药后的(32.4±13.3)％，差异有统计学意义（t=6.28，P＞0.05）；A、B两组间无统计学差异（t=1.62，P＜0.05）。结论A组与B组应用小剂量替罗非班均有良好的抗血小板作用，无严重出血并发症，安全性良好。
ClinicalEfficacyandSafetyoflow-doseofTirofibaninPercutaneousCoronaryInterventioninPatientswithAcuteCoronarySyndrome
ZhangXiao-Zhong，WangHong,ZhangJun,etal.CenterforInterventionalcardiology,AcademyofMilitaryMedicalSciences,DepartmentofCardiology,HospitalofPLA,Beijing,China.
ObjectiveToaccessclinicalefficacyandsafetyoflow-doseoftirofibaninpercutaneouscoronaryintervention(PCI)inpatientswithacutecoronarysyndrome(ACS).MethodspatientswithACS(90males,72females),whowereinlinewithPCIindicationsandreceivedcoronaryrevascularizationsuccessfully,wereenrolledanddividedintotwogroups.80patientsinGroupAweregivenintravenousdripoftirofibaninadoseof0.2μg·kg-1·min-1for30min(halfdoseofthatprovidedintheinstructions),thengivencontinuousintravenousdripinadoseof0.05μg·kg-1·min-1for24h-48h.ThedifferenceinGoupBwasthat82patientsweregiventirofibanafterPCI.Heparinorlow-molecular-weightheparinwasreducedbyhalf,andaspirinandclopidogrelweregivenbyconventional-dose.Deathforanyreason,newmyocardialinfarctionandrefractoryanginapectoriswereobservedwithin30daysafteruseoftirofiban.ResultsAmong30daysofmedicationinGroupA,onediedofacuteheartfailure(1.25％),nomoremyocardialinfarctionandrefractoryanginapectorisoccurred.InGroupB,onepresentedwithrefractoryanginapectoris(1.22％),nomoredeathandmyocardialinfarctionoccurred.Therewasnosignificantdifferencebetweenthetwogroups(X2=0.19,P＜0.05).InGroupA,fourcasespresentedwithmild–moderatebleeding(5.00％),.Threecasespresentedwithmild–moderatebleeding(3.66％)inGroupB.Noneseverebleedingoccurredintwogroups.Plateletaggregationratesweredownfrom(63.5±17.4)％to(31.7±13.5)％inGroupA.Thedifferenceisstatisticalsignificance(t=6.28，P＞0.05).Andplateletaggregationratesweredownfrom(64.1±18.2)％to(32.4±13.3)％inGroupB.Thedifferenceisalsostatisticalsignificance.(t=6.28，P＞0.05).Buttherewasnosignificantdifferencebetweenthetwogroups.ConclusionLow-doseoftirofibanisasafedrugwithagoodanti-plateleteffect,whoseusingtimeisflexiblebutnoseriousbleeding