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PCI术前应用替罗非班对急性心肌梗死患者相关指标的影响
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| 篇名： | PCI术前应用替罗非班对急性心肌梗死患者相关指标的影响 |
| TITLE： | |
| 摘要： | 目的：观察经皮冠状动脉介入治疗（PCI）术前应用替罗非班对急性心肌梗死患者相关指标的影响。方法：采用回顾性分析方法，选取2015年1月－2016年6月我院收治的急性心肌梗死患者128例，根据患者PCI术前是否应用替罗非班分为观察组（76例）和对照组（52例）。对照组患者PCI术前给予阿司匹林肠溶片300 mg，po+硫酸氢氯吡格雷片600 mg，po，术中给予肝素钠注射液100 U/kg，iv。观察组患者在对照组基础上于术前给予盐酸替罗非班氯化钠注射液0.2 μg/（kg·min），iv。观察两组患者术后ST段回落情况、胸痛改善情况，术前心肌酸激酶同工酶（CK-MB）水平和术后CK-MB峰值、达峰时间和持续时间，术后心肌梗死溶栓治疗（TIMI）血流分级，术前术后血管性假血友病因子（vWF）、血浆内皮素1（ET-1）和血清一氧化氮（NO）水平，并记录不良反应发生情况。结果：PCI术后，观察组患者ST段回落率（89.47％）明显高于对照组（67.31％），胸痛总缓解率（89.47％）明显高于对照组（75.00％），TIMI血流分级2～3级的患者明显多于对照组，差异均有统计学意义（P＜0.05）。PCI术前，两组患者CK-MB、vWF、ET-1和NO水平比较，差异均无统计学意义（P＞0.05）；PCI术后，观察组患者CK-MB峰值、达峰时间和持续时间均明显低于或短于对照组；两组患者vWF和ET-1水平均明显降低，NO水平明显升高，且观察组患者vWF、ET-1和NO水平的改善程度明显优于对照组，差异均有统计学意义（P＜0.05）。观察组患者轻度出血发生率明显低于对照组，中度出血发生率明显高于对照组，差异均有统计学意义（P＜0.05）；但两组患者死亡率比较，差异均无统计学意义（P＞0.05）。结论：PCI术前应用替罗非班可缓解患者临床症状，改善心功能，保护血管内皮，恢复冠状动脉血流灌注，但应注意其出血风险。 |
| ABSTRACT： | OBJECTIVE： To observe the effects of preoperative application of tirofiban on related indexes of patients with acute myocardial infarction. METHODS： In retrospective analysis， 128 patients with acute myocardial infarction selected from our hospital during Jan. 2015-Jun. 2016 were divided into observation group （76 cases） and control group （52 cases） according to whether or not the tirofiban was used before PCI. Control group was given Aspirin enteric-coated tablets 300 mg， po+ Clopidogrel sulfate tablets 600 mg， po， before PCI， and given Heparin sodium injection 100 U/kg ， iv， during PCI. Observation group was additionally given Tirofiban hydrochloride injection 0.2 μg/（kg·min），iv，before PCI，on the basis of control group. ST-segment depression and chest pain remission of 2 groups were observed after PCI. CK-MB level before surgery， CK-MB peak value， the time of CK-MB reaching the peak value， duration after surgery as well as TIMI blood flow grading after surgery were also observed in 2 groups. The levels of von Willebrand factor （vWF）， ET-1 and NO were observed before and after surgery； the occurrence of ADR was recorded. RESULTS： After PCI， ST-segment depression rate （89.74％） of observation group was significantly higher than that （67.31％） of control group， the chest pain remission rate （89.47％） was significantly higher than that of control group （75.00％）， the patients with TIMI blood flow grading grade 2-3 in observation group was more than control group， with statistical significance （P＜0.05）. Before PCI， there was no statistical significance in the levels of CK-MB， vWF， ET-1 and NO between 2 groups （P＞0.05）. After PCI， CK-MB peak value， the time of CK-MB reaching the peak value， duration in observation group were significantly lower or shorter than control group； the levels of vWF and ET-1 significantly decreased， while NO levels increased； the improvement of vWF， ET-1 and NO in observation group was significantly better than control group， with statistical significance （P＜0.05）. The incidence of mild bleeding in observation group was significantly lower than control group， while the incidence of moderate bleeding was significantly higher than control group， with statistical significance （P＜0.05）. There was no statistical significance in the incidence of death between 2 groups （P＞0.05）. CONCLUSIONS： The application of tirofiban before PCI can relieve clinical symptom， improve cardiac function， protect vascular endothelial and restore coronary artery perfusion. The attention should be paid to the risk of bleeding. |
| 期刊： | 2017年第28卷第20期 |
| 作者： | 李景瑞，李宇婷 |
| AUTHORS： | LI Jingrui，LI Yuting |
| 关键字： | 替罗非班；急性心肌梗死；经皮冠状动脉介入治疗；心肌血流灌注 |
| KEYWORDS： | Tirofiban； Acute myocardial infarction； Percutaneous coronary intervention； Myocardial perfusion |
| 阅读数： | 229 次 |
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