急性STEMI患者急诊经皮冠状动脉介入治疗中冠状动脉内注射负荷剂量盐酸替罗非班对心功能的影响

Effects of coronary injection of loading dose of tirofiban hydrocldoride in emergency percutaneous coronary intervention of acute STEMI on cardiac function

目的探讨急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）中冠状动脉内注射负荷剂量盐酸替罗非班对心功能的影响。方法选取2014年3月至2015年6月符合研究选取标准的86例STEMI患者，根据用药方案不同分为对照组与研究组，每组43例。对照组PCI术中采用氯化钠注射液，研究组采用盐酸替罗非班。对比术后两组再灌注相关指标[梗死相关血管（IRA）无复流、肌酸激酶同工酶（CK-MB）峰值、CK-MB峰值时间、ST段回落〉50.0%、TIMI3级血流水平、手术前后两组心功能相关指标[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）]水平变化情况，术后1年对两组患者进行随访，统计两组不良心血管事件发生率及远期存活率。结果研究组IRA无复流率（4.65%）、CK-MB峰值[（181.06±34.18）U/L]、CK-MK峰值时间[（10.16±1.61）h]、ST段回落〉50.0%率（93.02%）、TIMI3级血流率（95.35%）均显著优于对照组，差异有统计学意义（P〈0.05）。术前两组LVEF、LVEDD、LVESD水平比较差异未见统计学意义（P〉0.05）；治疗后，研究组各指标水平明显优于对照组，差异有统计学意义（P〈0.05）。研究组不良心血管事件发生率（9.31%）明显低于对照组（30.24%），术后1年存活率（95.35%）高于对照组（76.74%），差异有统计学意义（P〈0.05）。结论急性STEMI患者急诊经皮冠状动脉介入治疗中冠状动脉内注射负荷剂量盐酸替罗非班效果显著，可有效改善心肌再灌注状态及心功能，降低不良心血管事件发生率，改善预后，提高远期存活率。

ObjectiveTo investigate the effect of coronary injection of loading dose of tirofiban hydrochloride on emergency percutaneous coronary intervention （PCI） of patients with acute ST segment elevation myocardial infarction （STEMI） on cardiac function.MethodsEighty-six patients with STEMI from March 2014 to June 2015 were selected and divided into control group （n=43） and study group （n=43） according to the different treatment schemes.In the control group, PCI was treated with normal saline, and the study group was treated with hydrochloric acid. The postoperative reperfusion indexes [IRA no reflow and creatine kinase isoenzyme （CK-MB） peak, CK-MB peak time, ST segment decline〉50.0%, TIMI 3 flow] level, the cardiac function indexes before and after operation[ left ventricular ejection fraction （LVEF）, left ventricular end diastolic diameter （LVEDd）, left ventricular end diastolic diameter （LVESD）] levels were comparte between the two groups. One year after operation, the patients were followed up, the incidences of adverse cardiovascular events and long-term survival rates of the two groups were statistically analyzed.ResultsThe IRA without complex flow rate （4.65%） and peak CK-MB [（181.06±34.18） U/L], CK-MB peak time [（10.16±1.61） h], ST segment resolution〉50.00% rate （93.02%）, TIMI 3 flow rate （95.35%） in study group were significantly better than those of the control group, the differences were significant （P〈0.05）. There was no significant difference in LVEF, LVEDD or LVESD levels between the two groups （P〉0.05）. After treatment, the indexes in the study group were significantly better than those in the control group, the differences were significant （P〈0.05）; the incidence of adverse cardiovascular events （9.31%） in the study group was significantly lower than that in the control group （30.24%）, and the 1 year survival rate （95.35%） was significantly higher than that in the control group （76.74%）, and the differences were significant （P〈0.05）.ConclusionsThe effect of coronary injection of lodding dose of tirofiban hydrochloride on emergency PCI of patients with acute STEMI is significant, it can effectively improve the myocardial reperfusion and heart function, reduce the incidence of adverse cardiovascular events and improve the prognosis and increase the long-term survival rate.