探讨早期应用血小板膜糖蛋白（glycoprotein，GP）Ⅱb/Ⅲa拮抗剂替罗非班对老年急性ST段抬高型心肌梗死患者（ST-segment elevation myocardial infarction，STEMI）冠状动脉介入术后心肌血流再灌注的影响。

选取2009-2014年在第三军医大学西南医院老年病科就诊且为首发急性心肌梗死需急诊行冠状动脉支架植入术的52例STEMI患者，其中入院30 min内应用替罗非班治疗的患者纳入早期给药组（26例），入院30 min后应用替罗非班治疗的患者纳入为晚期给药组（26例），观察两组患者术前及球囊扩张后血流再灌注情况（TIMI血流分级和心肌呈色分级）、90 min ST段回落百分比，以及心血管不良事件（如30 d死亡、再发心肌梗死和因心肌梗死再住院等）的发生情况。组间比较采用t检验，率的比较采用χ²检验。

术前早期给药组TIMI 3级血流患者比例明显高于晚期给药组（23.1%、3.8%），心肌呈色分级达3级者比例亦明显高于晚期给药组（34.6%、11.5%），差异均有统计学意义（χ²=4.13、3.90，均P<0.05）；球囊扩张术后两组患者TIMI 3级血流和心肌呈色分级达3级者的比例均无明显差异（92.3%、88.5%，69.2%、65.4%；χ²=0.22、0.09，均P>0.05）。与晚期给药组比较，早期给药组90 min ST段回落百分比明显提高（88.5%、76.9%），差异有统计学意义（χ²=1.21，P<0.05）；而且早期给药组的手术时间明显缩短[（15±7）、（19±8）min]，差异有统计学意义（t=1.68，P<0.05）。两组患者均无30 d死亡、再发梗死及大出血等心血管不良事件发生，早期给药组仅2例发生小出血，晚期组仅1例再住院、2例发生小出血，两组患者出院后心血管不良事件发生率的差异无统计学意义（7.7%、11.5%；χ²=0.22，P>0.05）。

早期应用替罗非班可显著改善老年急性STEMI患者冠状动脉支架植入术后心肌血流的再灌注，且并未增加出血、死亡等临床不良事件的发生风险。

To explore the effect of early application of glycoprotein (GP)Ⅱb/Ⅲa antagonist on myocardial reperfusion in elderly patients with acute ST-elevation myocardial infarction (STEMI) taken coronary stenting.

Patients (n=52) from 2009 to 2014 in Department of Geriatrics, Xi'nan Hospital of Third Minitary Medical University, with a first onset of AMI receiving emergency coronary stenting were randomized to either early administration of tirofiban group which were admitted with tirofiban within 30min of admission (n=26) or later administration group which were given tirofiban after 30min of admission (n=26). The primary endpoints included the degree of TIMI flow and the percentage of ST segment depression at 90min, and 30-day major adverse cardiac events.T-test was utilized to compare between two groups, and kai-square test was applied to analyze the count data.

Angiographic analysis revealed a higher initial frequency of TIMI grade 3 flow in the early group (23% and 4%,χ²=4.13,P<0.05). Compared with the late group, the percentages of myocardial blush grade 3 (34.6% and 11.5%,χ²=3.90,P<0.05). The TIMI grade 3 and myocardial blush grade 3 before balloon ablation had no significant differences between the two groups (92.3% and 88.5%, 69.2% and 65.4%,χ²=0.22 and 0.09,P>0.05). ST segment depression at 90min in early group was significantly higher than in the later group (88.5% and 76.9%,χ²=1.21,P<0.05), and the surgery time in early group was significantly lower than the later group [(15±7) and (19±8)min,t=1.68,P<0.05). No 30-day death, recurrent MI or massive hemorrhage occurred in both groups. Two cases of minor hemorrhage in early group; one case of rehospitalization and 2 cases of minor hemorrhage in later group. No difference of cardiovascular events after discharge (8% and 12%,χ²=0.22,P>0.05).

The early administration of tirofiban could significantly improve myocardial reperfusion and clinical outcomes in aged patients of STEMI undergoing coronary stenting.