盐酸替罗非班对经皮穿刺冠状动脉成形术术后非ST段抬高型急性冠状动脉综合征患者不同时间的应用研究

Effect of different application time of tirofiban hydrochloride in the treatment of patients with NSTE-ACS and undergoing PCI surgery

目的探讨不同时间应用盐酸替罗非班对经皮穿刺冠状动脉成形术(PCI)非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者的影响。方法该院收治的93例NSTE-ACS患者行PCI术,被随机分为实验组(47例)和对照组(46例)。所有患者在常规药物治疗的基础上,实验组术前、对照组术中给予盐酸替罗非班治疗。观察患者30d内疗效;PCI术前后病变血管前向血流心肌梗死溶栓(TIMI)分级;术后1周出血并发症的发生率和血小板降低程度;术后24h内N-末端脑钠肽前体(NT-proBNP)水平。结果实验组和对照组患者30d内PCI术总有效率为93.62%和90.13%,2组比较差异无统计学意义(P>0.05);2组患者TIMI 3级均有显著性升高,且实验组高于对照组,差异有统计学意义(P<0.05);术后1周内2组患者均无严重出血事件发生,差异无统计学意义(P>0.05),血小板减少症发生率差异也无统计学意义(P>0.05);术后2组lg(NT-proBNP)水平均显著下降,且实验组低于对照组,差异有统计学意义(P<0.05)。结论 PCI术前应用盐酸替罗非班,可提高术后达到TIMI 3级血流患者比例,降低NT-proBNP水平。

Objective To investigate the effect of different application time of tirofiban hydrochloride in the treatment of patients with non-ST elevation acute coronary syndrome （NSTE-ACS） and undergoing PCI surgery. Methods 93 cases of NSTE-ACS patients in our hospital were randomly divided into experimental group （47 cases） and control group （46 cases）. On the basis of conventional medicine, all patients were administrated with tirofiban hydrochloride before （experimental group） or during PCI （control group）. The following indices were recorded： be- fore and after PCI,the forward flow TIMI scale of coronary arteries;postoperatively 1 week the bleeding occurrence rate and thrombocytopenia rate;the level of NT-proBNP before and postoperatively 24 h. Results The total effective rate of experimental group and control group in 30 d were 93. 62~ and 90. 13%, respectively, and no significant difference was found between them （P^0.05）. The ratio of patients at TIMI3 significantly increased and experimen- tal was better （P^0.05）. No severe bleeding incident occurred postoperatively 1 week,and there was no significant difference between the bleeding occurrence rate and thrombocytopenia rate of two groups （P^0.05）. The level of all patients significantly decreased after PCI 24 h, which was significant lower of experimental group, compared to that of control group （P^0.05）. Conclusion Compared to application of tirofiban hydrochloride during operation,applica tion before operation could improve the ration of patients at TIMI3 and decrease the level of NT-proBNP, but could not decrease the bleeding occurrence rate and thrombocytopenia rate and enhance total effective rate.