急性心肌梗死早期使用糖蛋白Ⅱb/Ⅲa受体拮抗剂对心率变异性的影响

Effects of early application of GPⅡb/Ⅲa receptor antagonists on heart rate variability in patients with acute myocardial infarction

目的探讨急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗前应用国产血小板膜糖蛋白(glycoprotein,GP)Ⅱb/Ⅲa受体拮抗剂替罗非班对心率变异性(heart ratevariability,HRV)的影响及临床意义。方法选择2009年12月至2010年12月在广州市第一人民医院心内科冠状动脉粥样硬化性心脏病(冠心病)监护病房住院,诊断为急性ST段抬高型心肌梗死的患者213例为研究对象。入选患者均接受急诊PCI治疗并按简单随机化分组(抛硬币法),分为实验组102例和对照组111例,实验组急诊PCI治疗前即使用替罗非班并持续静脉注射32～36 h,对照组则不使用替罗非班。两组均于术后24 h及术后第7天进行24 h动态心电图检查,分析两组HRV时域指标(SDNN、SDANN、rMSSD、PNN50)及住院期间恶性心律失常(室性心动过速、心室颤动及阵发性速率型心房颤动)事件发生的差异。结果两组临床基线特征及冠状动脉造影结果比较,差异无统计学意义(P>0.05)。实验组及对照组患者术后第7天HRV的各项时域分析指标与术后24 h比较有所升高,差异有统计学意义(P<0.05);实验组HRV的各项时域指标与对照组相比明显升高,差异有统计学意义(P<0.05)。实验组术后恶性心律失常事件的发生率明显低于对照组,差异有统计学意义(P<0.05)。术后第7天实验组左心室射血分数明显高于对照组,差异有统计学意义(51.25%±3.26%vs.49.94%±4.95%,t=-2.238,P=0.026)。结论急性ST段抬高型心肌梗死患者急诊PCI治疗前使用GpⅡb/Ⅲa受体拮抗剂替罗非班能改善患者的HRV,降低恶性心律失常事件的发生率,改善临床预后。

Objectives To investigate the effects and the clinical significance of early application of tirofiban as glycoprotein （GP） Ⅱb/Ⅲa receptor antagonists on heart rate variability （HRV） in patients with acute ST-segment elevation myocardial infarction （STEMI） before undergoing primary pereutaneous coronary intervention （PCI）. Methods We selected 213 patients with acute STEMI who hospitalized in Coronary Care Unit （CCU） of Guangzhou First People＇s Hospital from December 2009 to December 2010 as study cases. All the patients received primary PCI therapies and were coin randomized into two groups： 102 cases in experimental group in which tirofiban was intravenously injected for 32-36 h before primary PCI and 111 cases in control group in which tirofiban was not used. Patients in both groups accepted 24-hour dynamic electrocardiogram monitoring 24 hours and seven days after PCI. Time domain indexes （SDNN, SDANN, rMSSD, PNN50） of HRV,malignant arrhythmia events including ventricular tachycardia, ventricular fibrillation and paroxysmal tempo atrial fibrillation happened during hospitalization in both groups were evaluated and compared. Results Clinical baseline characteristics and coronary angiographic data in both groups had no significant difference（P〉0.05）. Time domain indexes of HRV in 7 days in both groups were significantly higher than those in 24 hours after primary PCI （P〈0.05）. Compared with control group, the time domain indexes of HRV in experimental group were significantly higher （P〈0.05）. Incidence rate of malignant arrhythmia events was obviously lower in experimental group than in control group（P〈0.05）. Patients in experimental group had higher left ventricular ejection fraction （LVEF） in7 days than patients in control group and the difference had statistical significance （51.25%±3.26% vs. 49.94%±4.95%, t=-2.238,P=0.026）. Conclusions Early application of tirofiban as glycoprotein （GP）Ⅱ b/Ⅲa receptor antagonists before primary PCI in patients with acute STEMI can improve patient＇s HRV and the clinical prognosis reduce incidence rate of malignant arrhythmia events.