替罗非班对行急诊经皮冠状动脉介入治疗ST段抬高性心肌梗死患者心肌灌注和心功能的影响

Impact of Tirofiban on Myocardial Perfusion and Cardiac Function of ST Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention

目的:探讨ST段抬高性心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)中使用盐酸替罗非班对心肌灌注和心功能的影响。方法:将广东省人民医院心内科收治的120例STEMI患者随机分为观察组和对照组各60例,观察组于术中冠脉注射盐酸替罗非班(10μg/kg),对照组注射等量0.9%氯化钠。比较两组术后即时造影检查结果、术后校正TIMI帧数、磷酸肌酸激酶同工酶(CK-MB)峰值及峰值时间、术后2hST段回落程度及住院期间的出血并发症,比较两组术后7 d、30 d、90 d的左室舒张末期内径(LVEDD)、左室射血分数(EF)、左室收缩末期内径(LVESD)及术后90 d不良心血管事件(MACE)发生情况。结果:观察组患者术后即时造影、校正TIMI帧数、磷酸肌酸激酶同工酶峰值及到达峰值时间、术后2 h sT段回落程度均明显优于对照组(P<0.05);观察组患者术后90 d MACE发生率明显低于对照组(P<0.05),但住院期间出血并发症的发生率无明显差异(P>0.05);观察组患者术后7 d、30 d、90 d的左室EF较对照组明显增加,LVEDD、LVESD较对照组明显降低(P<0.05)。结论:STEMI患者行急诊PCI治疗中,给予冠脉注射盐酸替罗非班可有效减少慢血流、无复流的发生率,改善左室功能和心肌水平再灌注状态。

Objective： To investigate the impact of tirofiban on myocardial perfusion and cardiac function of ST segment elevation myocardial infarction （STEMI） treated by pereutaneous coronary intervention （PCI）. Methods： 120 patients with STEMI in Department of Cardiology, Guangdong General Hospital were randomly divided into observation group（n=60） and control group（n=60） and were given tirofiban（10 μg/kg） and equal amount of 0.9% sodium chloride in intraoperative coronary respectively. The immediate angiograpby results,corrected TIMI frame count, creatine kinase （CK-MB） peak and peak time,ST- drop degree after 2 h,and bleeding complications during hospitalization, left ventricular end-diastolic diameter （LVEDD）, left ventricular ejection fraction （EF）, left ventricular systolic diameter （LVESD） at 7d, 30d, 90d and adverse cardiovascular events （MACE） in 90 d were compared between the two groups. Results： The immediate angiography results, corrected TIMI frame count, CK-MB peak and peak time, ST- drop degree after 2 h, and bleeding complications during hospitalization in observation group were significantly better than those in the control group （P〈0.05）, but MACE rate in observation group was significantly lower than that in the control group （P〈0.05）.There was no significant difference in the bleeding complications rate during hospitalization between the two group （P〉 0.05）. The left ventricular EF in observation group at 7 d, 30 d, 90 d were significantly increased than those in the control group （P〈0.05）, but LVEDD and LVESD in observation group were significantly reduced than those in the control group （P〈0.05）. Conclusion： Patients with STEMI treated by PCI given tirofiban hydroehloride injection can effectively reduce slow flow and no-reflow incidence, and improve left ventricular function and myocardial reperfusion state level.