替罗非班对经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者心功能及心肌灌注的影响

Effect of Tirofiban on the cardiac function and myocardial perfusion in patients with acute ST segment elevation myocardial infarction with percutaneous coronary intervention

目的探讨研究替罗非班对经皮冠状动脉介入治疗急性sT段抬高型心肌梗死患者心功能及心肌灌注的影响。方法随机选取2012年9月至2014年9月经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者80例作为研究对象，采用随机数字表法将其分为实验组（36例）和对照组（44例）。对照组患者均给予常规药物治疗，实验组患者在常规药物治疗基础上均给予替罗非班治疗，对比两组患者心功能和心肌灌注变化情况。结果心肌灌注：实验组术后TIMI3级血流比例和对照组比较差异未见统计学意义（P〉0．05），而校正TIMI帧数、肌酸激酶同工酶（CK—MB）峰值和梗死相关动脉（IRA）无复流比例均远低于对照组（P〈0．05），ST段回落1〉50％比例远高于对照组（P〈0．05）。心功能：实验组术后7d、术后1个月和术后6个月的射血分数（EF）指标均显著高于对照组（P〈0．05），而左室收缩末期内径（LVESD）和左室舒张末期内径（LVEDD）均显著低于对照组（P〈0．05）。不良反应和心血管事件：两组不良反应比较差异未见统计学意义（P〉0．05）；实验组术后12个月内不良心血管事件发生率（2．78％）与对照组（20．45％）比较差异有统计学意义（P〉0．05）。结论采用替罗非班对经皮冠状动脉介入治疗急性sT段抬高型心肌梗死可以减轻心肌灌注损伤，改善心功能，降低心血管不良事件发生率。

Objective To study the effect of Tirofiban on the cardiac function and myocardial perfusion in patients with acute ST segment elevation myocardial infarction with percutaneous coronary intervention. Methods Eighty patients with acute ST segment elevation myocardial infarction needed the treatment of percutaneous coronary intervention from September 2012 to September 2014 were randomly selected and divided into experiment group （36 cases） and control group （44 cases） according to the random number table method. The patients in the control group were given conventional medicine treat- ment, and the patients in the experiment group were treated with tirofiban hydrochloride based on the routine medicine treatment, then the heart function and myocardial perfusion changes of the two groups were compared. Results Myocardial perfusion： the rate of TM1 3 blood flow ratio after surgery in the experi- ment group was not significanty different compared with that in the control group （ P 〉 0. 05 ）, and corrected TM 1 frames, peak value of CK-MB and the rate of RA no reflow ratio were much lower than those in the control group （ P 〈 0. 05 ）, and the rate of ST segment fell more than or equal to 50% was much higher than that in the control group （P 〈 0. 05 ）. Cardiac function： the EF indexes 7days, 1 month and 6 months after operation in the experiment group in the experiment group were significantly higher than those in the control group （P 〈 0. 05）, while LVEDD and LVESD were significantly lower than those in the control group （P 〈 0. 05）. Adverse reactions and cardiovascular events ： the difference of adverse reactions between the two groups was not significantly different （ P 〉 0. 05 ）, the incidence of cardiovascular events within 12 months after the operation between the experiment group （2. 78 % ） and the control group （20. 45% ） was significant different（P 〈0. 05）. Conclusions Tirofiban hydrochloride in the treatment of patients with acute ST segment elevation myocardial infarction with percutaneous coronary intervention can reduce myocardial perfusion injury, improve cardiac function, and reduce the incidence of adverse cardiovascular events.