未行早期介入治疗的急性非ST段抬高心肌梗死应用替罗非班的临床分析

Clinical Analysis of Tirofiban in Acute Non-ST-segment Elevation Myocardial Infarction without Early Interventional Therapy

目的:探讨未行早期介入治疗的急性非ST段抬高心肌梗死(Not ST-elevation myocarial infarction,NSTEMI)患者应用替罗非班的有效性和安全性。方法:随机抽取64例NSTEMI患者,通过随机数表法分组,各32例。对照组采用常规治疗(口服阿司匹林、氯吡格雷,皮下注射低分子肝素),持续治疗5~7 d。研究组在常规治疗基础上加用替罗非班,共静脉滴注48 h。统计治疗48 h后2 d内两组不良心血管事件发生率、心肌灌注(TMPG)情况,并实施心脏超声检查,对比治疗前后两组左心室射血分数(LVEF)及血小板聚集率、血小板计数变化情况。结果:研究组不良心血管事件发生率(12.51%)低于对照组(34.38%),差异有统计学意义(P<0.05);治疗后两组LVEF、血小板聚集率均较治疗前明显改善,且研究组LVEF高于对照组,血小板聚集率低于对照组,差异有统计学意义(P<0.05);研究组TMPG3级率(87.50%)高于对照组(52.50%),差异有统计学意义(P<0.05)。结论:给予未行早期介入治疗的急性非ST段抬高心肌梗死患者替罗非班效果显著,可有效提高左心室射血分数,降低血小板聚集率及不良心血管事件发生率,改善心肌灌注,安全性较高,具有推广价值。

Objective： To evaluate the efficacy and safety of tirofiban in patients with acute non - ST - segment ele- vation myocardial infarction （NSTEMI） without early interventional therapy. Methods：64 patients with NSTEMI were randomly divided into the control group and the study group. The control group was treated with conventional therapy （ aspirin, clopidogrel and subcutaneous injection of low molecular weight heparin）, then continuously treated for 5 to 7 d. Based on the treatment of control group, the study group was treated with tirofiban, which was a total of intravenous infusion for 48h. The incidence of adverse cardiovascular events, myocardial perfusion （TMPG） were statistically ana- lyzed 2 days after the treatment, and a cardiac ultrasound examination was performed. The left ventricular ejection frac- tion （LVEF）, platelet aggregation rate and platelet count were measured before and after treatment. Results：The inci- dence of adverse cardiovascular events in the study group was 12.51% , which was lower than that in the control group （ 34.38% ）. There was statistically significant difference （ P 〈 0.05 ）. The LVEF and platelet aggregation rate of the two groups were significantly improved after treatment. The LVEF of the study group was higher than that of the control group, and the platelet aggregation rate was lower than the control group （P 〈 0.05 ） ; the level rate of TMPG3 in the study group （87.50%） was higher than that in the control group （52.50%）. There was statistically significant differ- ence （ P 〈 0.05 ）. Conclusions： It is significant that the effect of tirofiban in patients with acute non - ST - segment ele- vation myocardial infarction without interventional therapy, which can effectively improve the left ventricular ejection fraction, reduce platelet aggregation rate and the incidence of adverse cardiovascular events, and especially can strength- en myocardial perfusion, with high security and worth promoting.