早期应用替罗非班对急性ST段抬高型心肌梗死行PCI术患者心功能的影响及安全性研究

The Efficacy of Early Using Tirofiban on Heart Function in Patients with Acute STsegment Elevated Myocardial Infarction Accepted PCI and Its Safety

目的观察早期应用替罗非班对急性ST段抬高型心肌梗死行经皮冠状动脉介入术(PCI)患者心功能的影响及安全性。方法将60例急性ST段抬高型心肌梗死患者根据替罗非班给药时间随机分为早期组(入急诊室PCI术前即开始给予替罗非班)、对照组(PCI术中给予替罗非班),每组30例。比较两组患者术前、术后血浆N端B型利钠肽原(NT-pro BNP)、心肌肌钙蛋白I(c Tn I)水平变化,左心室收缩期末内径、左心室舒张期末内径、左心室射血分数(LVEF)的变化,术后24 h和30天内主要不良心脏事件(MACE)及出血发生率的差异。结果与对照组相比,早期组术后1周NT-pro BNP水平显著下降(P<0.01),术后24 h及1周后c Tn I水平明显降低(P<0.01)。两组患者术后1周左心室收缩期末内径、左心室舒张期末内径差异均无统计学意义(P>0.05),LVEF早期组显著高于对照组(P<0.05)。两组MACE及出血发生率差异无统计学意义(P>0.05)。结论急性ST段抬高型心肌梗死患者在急诊PCI术前早期应用替罗非班能明显提高LVEF,改善心功能,安全性好。

Aim To study the efficacy of early using tirofiban on heart function in patients with acute ST-segment elevation myocardial infarction（ STEMI） accepted percutaneous coronary intervention（ PCI） and its safety. Methods According to tirofiban administration time,60 cases of patients with STEMI were randomly divided into two groups：（ 1）early group（ n = 30） ： tirofiban was given before entering the emergency room and PCI;（ 2） control group（ n = 30） ： tirofiban was given during the PCI operation. The level of N-terminal pro-B-type natriuretic peptide（ NT-pro BNP） and cardiac troponin I（ c Tn I） were measured. The changes of left ventricular end-systolic diameter（ LVESD）,left ventricular enddiastolic diameter（ LVEDD） and left ventricular ejection fraction（ LVEF） were observed. In addition,main adverse cardiac event（ MACE） and the incidence of bleeding complication were compared in 24 hours and 30 days after PCI. Results Compared with the control group,NT-pro BNP was significantly decreased in 1 week after PCI,and c Tn I was significantly decreased in 24 hours and 1 week after PCI in the early group（ P〈 0. 01）. There were no significant differences in LVESD and LVEDD in 1 week after PCI between two groups（ P〉 0. 05）,but LVEF was significantly higher in the early group than that in the control group（ P 〈0. 05）. There were no significant differences in MACE and the incidence of bleeding between the two groups（ P〉 0. 05）. Conclusion Early administration of tirofiban before emergency PCI can significantly increase LVEF and improve heart function in patients with acute STEMI,furthermore,safety is good.