急性心肌梗死早期使用GpⅡb/Ⅲa受体拮抗剂对窦性心律震荡的影响及临床意义

The Influence and Clinical Significance of Early Application of GpⅡb/Ⅲa Receptor Antagonist to Heart Rate Turbulence in Patients with Acute Myocardial Infarction

目的探讨急性sT段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉腔内介入治疗（PCI）术前应用国产血小板膜糖蛋白GpⅡb／Ⅲa受体拮抗剂替罗非班对窦性心律震荡（HRT）的影响及临床意义。方法连续收集2008年12月至2010年12月在我院心内科ccu住院诊断为STEMI的患者202例．入选病例均接受直接PCI治疗并分为实验组98例和对照组104例，实验组直接PCI术前即使用替罗非班并持续静脉滴注维持32—36小时，对照组则不使用替罗非班。两组患者均于术后48小时进行24小时动态心电图检查，计算窦性心律震荡指标震荡初始（To）、震荡斜率（Ts），分析两组患者To、Ts的差异及与术后6个月内主要心脏不良事件（MACE）发生的关系。结果两组患者的临床基线特征及冠脉造影资料无明显差异，实验组患者HRT指标To、Ts值均优于对照组，并且术后6个月内MACE的发生率明显低于对照组，差异有统计学意义（P〈0．05）。多因素Logistic回归分析显示直接PCI术前早期应用替罗非班及Ts均是STEMI患者直接PCI术后近期预后的独立预测因子。结论STEMI患者直接PCI术前使用GpⅡb／Ⅲa受体拮抗剂替罗非班能改善患者的HRT，降低MACE的发生率，改善临床预后。

Objective To investigate the influence and clinical significance of early application of tirofiban in heart rate turbulence （HRT） patients with ST-segment elevation myocardial infarction （STEMI） who received primary percutaneous coronary intervention （PCI） therapies. Methods 202 cases of STEMI patients hospitalized in Cardiac Care Unit （CCU） in our department from December 2008 to December 2010 were continuous collection. All the patients received primary PCI therapies and were randomly divided into two groups： 98 cases in experimental group in which tirofiban was used to intravenous drip for 32 - 36 hours before primary PCI and 104 cases in control group in which tirofiban hadn＇t been used. Patients in both groups accepted 24 hour holter monitoring electrocardiogram examinations 48 hours after PCI. The indexes of HRT including turbulence onset （To）, turbulence slope （Ts） and major adverse cardiac events （MACE） that took placed within 6 months after PCI in both groups were measured and compared. Results The clinical baseline characteristics and coronary arteriography data in both groups had no significant difference, the HRT indexes To and Ts in experimental group were superior than control group and the incidence rate of MACE was lower （P 〈0.05）. Multiple factors logistic regression analysis indicated that early application of tirofiban and Ts were two strong independent predictive factors for the recent prognosis of STEM/patients received primary PCI therapies. Conclusion Early application of tirofiban before primary PCI in patients with STEM/can improve patients＇ HRT and clinical prognosis, reduce incidence rates of MACE.