替罗非班对STEMI患者心脏动脉血流及脑钠肽的影响

Influence of tirofiban on cardiac arterial blood flow and brain natriuretic peptide in patients with acute ST-segment elevation myocardial infarction

目的分析替罗非班对急性ST段抬高型心肌梗死(STEMI)患者心脏动脉血流及脑钠肽(BNP)水平的影响。方法选取2013年1月~2016年3月于新乡市第一人民医院治疗的STEMI患者122例,其中男性72例,女性50例,年龄59~70岁,平均年龄(65.49±10.03)岁。采用随机数字表法,将患者随机分为观察组(n=58)和对照组(n=64)。所有患者均于心肌梗死发病12 h内行急诊冠状动脉介入治疗(PCI)。观察组患者术前静脉推注盐酸替罗非班,PCI术中持续静脉泵入至结束。对照组给予生理盐水。于术前和术后1个月行心脏超声检查,测定左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)及左室射血分数(LVEF),同时检测BNP水平。测定两组术后3个月TIMI血流分级和心肌灌注分级。随访术后一年心脏不良事件发生情况。结果两组术后TIMI 3级血流患者比较,差异无统计学意义(P>0.05);观察组术后心肌灌注TIMI 3级比例明显高于对照组,87.9%vs.70.3%,差异有统计学意义(P<0.05)。两组术后LVEF较术前均增加,观察组术后LVEDD较术前有所下降,差异有统计学意义(P均<0.05)。观察组术后LVEF明显高于对照组,差异有统计学意义(P<0.05)。两组术后BNP水平较术前均降低,差异有统计学意义(P均<0.05)。观察组术后BNP为(178.83±51.06)pg/m L,明显低于对照组的(250.56±48.81)pg/m L,差异有统计学意义(P<0.05)。观察组心脏不良事件发生率明显低于对照组(5.2%vs.17.2%),差异有统计学意义(P<0.05)。结论 STEMI患者加用替罗非班,可改善PCI术后心肌灌注、心功能及BNP水平,减少心脏不良事件发生。

Objective To analyze the influence of tirofiban on cardiac arterial blood flow and brain natriuretic peptide （BNP） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods STEMI patients （n=122, male 72, female 50, aged from 59 to 70 and average age=65.49±10.03） were chosen from the First People’s Hospital of Xinxiang City from Jan. 2013 to Mar. 2016. The patients were divided into observation group （n=58） and control group （n=64） by using random digital table. All patients were given emergency percutaneous coronary intervention （PCI） within 12 h after onset of myocardial infarction. The observation group was given intravenous injection of tirofiban before PCI and intravenous pumping continuously during PCI to the end. The control group was given saline water. All patients were given examination of echocardiogram for detecting left ventricular end-systolic diameter （LVESd）, left ventricular end-diastolic inner diameter （LVEDd） and left ventricular ejection fraction （LVEF） before and 1 month after PCI, and level of BNP was detected at the same time. TIMI grading and myocardial perfusion grading were determined after PCI for 3 months, and incidence of major adverse cardiovascular events （MACE） were followed up after PCI for 1 y. Results The difference in patients with grade 3 TIMI had no statistical significance between 2 groups after PCI （P〉0.05）. The percentage of patients with grade 3 TIMI was significantly higher in observation group than that in control group （87.9% vs. 70.3%, P〈0.05）after PCI. LVEF increased in 2 groups, LVEDd decreased in observation group after PCI （all P〈0.05）. LVEF was significantly higher in observation group than that in control group after PCI （P〈0.05）. The level of BNP decreased in 2 groups after PCI （all P〈0.05）. The level of BNP was significantly lower in observation group （178.83±51.06） pg/mL than that in control group （250.56±48.81） pg/mL after PCI （P〈0.05）. The incidence of MACE was significantly lower in observation group than that in control group （5.2% vs. 17.2%, P〈0.05）. Conclusion Tirofiban can improve myocardial perfusion, heart function and BNP level, and reduce incidence of MACE in STEMI patients.