早期应用替罗非班对急性冠脉综合征择期冠脉介入治疗心肌微循环灌注及左心室功能的影响

Effects of Tirofiban on Myocardium Ischemia-reperfusion and Left Ventricular Function of Patients with Acute Coronary Syndromes Undergoing Delayed Percutaneous Coronary Intervention

目的探讨早期应用血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班对急性冠脉综合征(ACS)患者行择期冠状动介入治疗(择期PCI)时心肌微循环灌注及左心室功能的影响,了解替罗非班早期应用是否可以改善ACS患者择期PCI术前术后心肌微循环灌注和后期左心室功能,从而改善ACS临床预后。方法选择2013年1月至2015年1月我院心内科住院治疗的非急诊PCI ACS患者150例,采用简单随机抽样法将其平均分为观察组75例(替罗非班+标准药物治疗)和对照组75例(标准药物治疗),1周后均行冠状动脉造影及PCI治疗。比较两组患者冠脉造影TIMI血流水平分级、PCI术后校正的TIMI血流帧数(CTFC)、PCI术前和术后1、3、6个月左心室功能指标[血浆NT pro BNP、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)]以及出血并发症发生率。结果两组患者冠脉造影病变血管(IRA)TIMI血流水平分级差异无统计学意义(P>0.05);而PCI术后替罗非班组IRA CTFC明显低于对照组,差异有统计学意义(P<0.01);术前、术后1个月左心功能指标BNP、LVEF、LVEDD、LVESD两组比较差异无统计学意义(P>0.05);而术后3、6个月左心功能各项指标替罗非班组明显优于对照组,差异有统计学意义(P<0.05);观察两组术前术中术后出血并发症发生率,差异无统计学意义(P>0.05)。结论急性冠脉综合征患者早期应用替罗非班可以明显改善择期PCI术后心肌微循环灌注,改善后期左心室功能,而出血并发症发生率无明显增加,从而为失去急诊血运重建的ACS患者寻找一条新的改善预后的治疗方法,为临床应用提供参考价值。

Objective To explore the effects of platelet membrane glycoprotein GPllb/llla receptor antagonists tirofiban on myocardium ischemia-reperfusion and left ventricular function of patients with acute coronary syndromes（ ACS） undergoing delayednbsp;percutaneous coronary intervention（ delayed PCI） ,and to find out whether early administration of tirofiban in patients with ACS can improve myocardium ischemia – reperfusion before and after delayed PCI and left ventricular function at late stage and the prognosis of ACS. Methods 150 non-emergency hospitalized patients with ACS treated in our department of cardiology were selected and simply randomized into observation group（tirofiban plus routine therapy,n=75）and control group（routine therapy only,n=75）. All patients were given coronary artery angiograph and PCI after one week. The degree of TIMI flow,corrected TIMI frame count（ CTFC） after PCI,left ventricular function indexes（ NT pro BNP,LVEF,LVEDD,LVESD） and the incidence of bleeding complications examined before and 1,3,6,and 12 months after delayed PCI were compared and analyzed. Results The difference in the degree of TIMI flow of infarct-related artery（IRA）between two groups was not statistically significant（P〉0. 05）. CTFC of IRA after delayed PCI in the tirofiban therapy group was significantly lower than that in control group（P〈0. 01）. The difference in left ventricular function indexes （NT pro BNP,LVEF,LVEDD,LVESD）was also not statistically significant before and 1 months after delayed PCI（P〉0. 05）. Left ventricular function indexes in the tirofiban therapy group were significantly better than those in the control group 3 and 6 months after delayed PCI（P〈0. 01）. And the difference in the incidence of bleeding complications of two groups was not statistically significant （P〉0. 05）. Conclusions Early administration of tirofiban in patients with ACS undergoing delayed PCI improves myocardial reper-fusion and the prognosis of left ventricular function,without significant increase of the incidence of bleeding complications. Thus it helps patients with ACS who missed emergency revascularization to find a new treatment to improve the prognosis and provides reference for clinical application.