目的 为考察替罗非班联合比伐卢定对ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后心肌灌注的影响。方法 以110例行急诊PCI的STEMI患者为研究对象，根据随机数字表法分为对照组和联合组，每组55例，对照组于术前给予比伐卢定静脉注射，联合组在对照组的基础上给予替罗非班治疗。观察TIMI血流分级、ST段回降百分比、30 d不良心脏事件。结果 联合组患者TIMI血流分期情况显著优于对照组，差异有统计学意义（P<0.05）。联合组患者术后ST段回降情况显著优于对照组，差异有统计学意义（P<0.05）。对照组30 d不良心脏事件主要为心绞痛、Q波性心肌梗死及出血，总发生率为15.36%，联合组30 d不良心脏事件主要为心绞痛和出血，总发生率为5.45%，联合组30 d不良心脏事件总发生率显著低于对照组，差异有统计学意义（P<0.05）。结论 替罗非班联合比伐卢定能有效改善患者术后心肌灌注情况，减少患者术后不良心脏事件，安全性较高。

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.

安徽省卫计委科研项目（全科医学临床科研课题2016QK067）；蚌埠医学院重点科研项目（科技发展基金BYKF1757）