目的 為考察替羅非班聯(lián)合比伐盧定對ST段抬高型心肌梗死（STEMI）患者經皮冠狀動脈介入（PCI）術后心肌灌注的影響。方法 以110例行急診PCI的STEMI患者為研究對象，根據隨機數(shù)字表法分為對照組和聯(lián)合組，每組55例，對照組于術前給予比伐盧定靜脈注射，聯(lián)合組在對照組的基礎上給予替羅非班治療。觀察TIMI血流分級、ST段回降百分比、30 d不良心臟事件。結果 聯(lián)合組患者TIMI血流分期情況顯著優(yōu)于對照組，差異有統(tǒng)計學意義（P<0.05）。聯(lián)合組患者術后ST段回降情況顯著優(yōu)于對照組，差異有統(tǒng)計學意義（P<0.05）。對照組30 d不良心臟事件主要為心絞痛、Q波性心肌梗死及出血，總發(fā)生率為15.36%，聯(lián)合組30 d不良心臟事件主要為心絞痛和出血，總發(fā)生率為5.45%，聯(lián)合組30 d不良心臟事件總發(fā)生率顯著低于對照組，差異有統(tǒng)計學意義（P<0.05）。結論 替羅非班聯(lián)合比伐盧定能有效改善患者術后心肌灌注情況，減少患者術后不良心臟事件，安全性較高。

Objective To investigate the effect of tirofiban combined with bivalirudin on myocardial perfusion after emergency PCI in STEMI patients. Methods 110 patients with ST-segment elevation (STEMI) were enrolled in this study and divided into control group and combined group according to the random number table, each group of 55 cases. The control group was given intravenous injection of bivalirudin, and the combined group was treated with tirofiban on the basis of the control group. The TIMI blood flow classification, ST segment return percentage, 30 days of adverse cardiac events were observed. Results The TIMI blood flow staging in the combined group was significantly better than that in the control group (P<0.05). The ST segment recovery in the combined group was significantly better than that in the control group (P<0.05), The 30d MACE in the control group was mainly angina pectoris, Q wave myocardial infarction and hemorrhage, and the total incidence rate was 15.36%; The main 30d MACE in the combined group was mainly angina and hemorrhage, the total incidence rate was 5.45%. The overall incidence of MACE was significantly lower in the combined group than that in the control group (P<0.05). Conclusions Tirofiban combined with bivalirudin can improve the postoperative myocardial perfusion and reduce the postoperative adverse cardiac events with high safety.

安徽省衛(wèi)計委科研項目（全科醫(yī)學臨床科研課題2016QK067）；蚌埠醫(yī)學院重點科研項目（科技發(fā)展基金B(yǎng)YKF1757）