替罗非班在急性ST段抬高型心肌梗死患者PCI术前治疗中的应用效果

Application effect of Tirofiban in patients with acute ST segment elevation myocardial infarction before PCI

目的探讨替罗非班在急性ST段抬高型心肌梗死患者经皮冠状动脉介入(PCI)术前治疗中的应用效果。方法选择2012年1月~2016年6月宝鸡市中医医院收治的60例急性ST段抬高型心肌梗死患者为研究对象并进行临床资料的回顾性分析,根据治疗方式的不同将患者分为研究组和对照组,每组各30例。PCI术前及术后1周、术后3个月、术后6个月,检测并比较两组患者的左心室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD);观察两组患者PCI术后2 h ST段回落≥50%、TIMI 3级血流患者占比及肌酸激脢(CKMB)峰值、CK-MB峰值时间;比较PCI术后30、60 d两组患者不良心血管事件(MACE)的发生情况。结果 PCI术后1周、3个月、6个月,两组患者的LVEF均得到了明显提高,且与本组术前比较,差异有统计学意义(P<0.05);PCI术后1周、3个月、6个月两组LVEF比较,差异有统计学意义(P<0.05)。PCI术后两组患者的LVESD、LVEDD均较术前升高,但差异无统计学意义(P>0.05)。研究组患者PCI术后2 h ST段回落≥50%患者占比及CK-MB峰值明显高于对照组,CK-MB峰值时间少于对照组,差异有统计学意义(P<0.05)。两组患者术后MACE的发生率比较,差异有统计学意义(P<0.05)。术后两组患者均发生了轻度出血现象,研究组总发生率稍高于对照组,但异无统计学意义(P>0.05)。结论急性ST段抬高型心肌梗死患者PCI术前治疗中应用替罗非班可明显改善患者的心肌微循环及心功能,对患者的近期临床预后具有积极作用。

Objective To study the effect of Tirofibanin patients with acute ST segment elevation myocardial infarction before PCI. Methods 60 patients with acute ST segment elevation myocardial infarction from January 2012 to June 2016 in Hospital of Traditional Chinese Medicine of Baoji City were selected and divided into research group and the control group with 30 cases in each group according to the different treatment methods. The clinical data were retro- spectively analyzed. Preoperative and 1 week,3 months, 6 months after operation,the left ventricular ejection fraction （LVEF）, left ventricular end systolic diameter （LVESD）, left ventricular end-diastolic diameter （LVEDD） of patients in the two groups were tested and compared; the proportion of patients with ST segment fell ≥ 50% 2 h after PCI, flow ratio of TIMI3 and peak of creatine induced enzymes （CK-MB） and peak time of CK-MB were observed. Results 1 week, 3 months, 6 months after PCI, LVEF of the two groups both increased （P 〈 0.05）; and there was significant difference between the two groups （P 〈 0.05）. LVESD and LVEDD of the two groups after operation were higher than before operation, but the change had no significant difference （P 〉 0.05）. The proportion of patients with ST segment fell 2 h after operation ≥ 50% and CK-MB peak in the research group were higher than those of the control group, peak time of CK-MB was less than the control group, with significant difference （P 〈 0.05）; the occurrence of adverse cardiovascular events after operation in the two groups was statistically significant（P 〈 0.05）. Hyporrhea happened in the two groups after operation, the total rate of the research group was slightly higher than the control group,but there was no statistically significant difference （P 〉 0.05）. Conclusion Tirofiba can obviously improve the myocardial microcirculation and cardiac function of patients with acute ST segment elevation myocardial infarction after PCI, plays a positive role in the recent clinical prognosis of patients.