围术期应用替罗非班在急性心肌梗死老年患者介入治疗中价值

Value of tirofiban to percutaneous coronary intervention in elderly patients with acute myocardial infarction

目的探讨老年急性心肌梗死(acute myocardial infarction,AMI)患者在经皮冠状动脉介入术围术期预先应用替罗非班的临床效果。方法经右侧桡动脉径路行经皮冠状动脉介入术的AMI老年患者90例随机分为观察组和对照组各45例,观察组于术前30min、对照组于术后30min给予盐酸替罗非班氯化钠注射液10μg/kg,3min内静脉注射完毕后,继以0.15μg/(kg·min)微量泵维持24h。比较2组手术前、后TIMI血流情况、血小板相关补体1(platelet associated complement 1,PAC1)及P选择素(cluster of differentiation 62platelet,CD62P)阳性表达率、脂联素水平,测定左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、短轴收缩率(fractional shortening,FS)和左室射血分数(left ventricular ejection fraction,LVEF),并随访1个月观察不良心脏事件发生情况。结果观察组术后3个月梗死相关血管TIMI 3级血流获得率(95.6%)高于对照组(82.2%)(P<0.05);2组术后1dPAC1、CD62P阳性表达率和脂联素水平及术后7dLVESD、FS和LVEF与治疗前比较差异均有统计学意义(P<0.05);2组术后1dPAC1、CD62阳性表达率、脂连素水平比较差异有统计学意义(P<0.01),术后7dLVESD、FS和LVEF及术后1个月不良心脏事件发生率比较差异无统计学意义(P>0.05)。结论老年AMI患者经皮冠状动脉介入围术期预先应用替罗非班,可提高治疗成功率。

Objective To explore the clinical effect of pre-use of tirofiban in the elderly patients with acute myocardial infarction （AMI） treated by percutaneous coronary intervention （PCI）. Methods Ninety elderly patients with AMI treated by PCI via right radial artery were randomly divided into observation group and control group, with 45 patients in each group. Tirofiban （10 μg/kg） was given intravenous injection 30 minutes before PCI in observation group, and 30 minutes after PCI in control group with 3 minutes, followed by continuous pump of tirofiban at 0.15μg/（kg· min） for 24 hours. The TIMI flow, platelet associated complement 1 （PAC1）, the positive rate of cluster of differentiation 62 platelet （CD62）, adiponcetin, left ventricular end-systolic dimension （LVESD）, fractional shortening （FS）, left ventricular ejection fraction （LVEF） were compared before and after PCI between two groups. The major adverse cardiac events （MACE） were followed up for one month. Results TIMI 3 flow rate was 95.6 % in observation group, higher than that in control group （82.2%） （P〈0.05）. There were significant differences in the positive rates of PAC1 and CD62P, and adiponcetin level by day 1 after operation, and in LVESD, FS and LVEF by day 7 after operation in both groups compared with before treatment （P〈0.05）. There were significant differences in the positive rates of PAC1 and CD62P, and adiponcetin level by day 1 after operation between two groups （P〈0.05）, and no significant differences in LVESD, FS and LVEF by day 7 after operation and the incidence rate of MACE in one month after operation between two groups （P〈0.05）. Conclusions The pre-use of tirofiban can improve the success rate of PCI in the elder patients with AMI undergoing PCI.