盐酸替罗非班辅助经皮冠状动脉介入治疗在急性ST段抬高型心肌梗死患者中的应用价值

Application value of tirofiban hydrochloride during percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

目的 探讨在急性ST段抬高型心肌梗死（STEMI）患者中采用盐酸替罗非班辅助经皮冠状动脉介入（PCI）治疗的临床应用价值。方法 选取2014年1月至2015年6月于山东省青岛市胶州中心医院行PCI术的72例急性STEMI患者为研究对象，按照随机数字表法分为对照组和观察组，各36例。PCI中对照组给予0.9%氯化钠注射液辅助，观察组给予盐酸替罗非班辅助，观察对比2组梗死相关血管（IRA）血流灌注情况、心功能指标及术后不良心血管事件发生率。结果 术前2组患者IRA血流灌注情况比较差异无统计学意义（P＞0.05）；术后2组血流灌注情况明显优于术前，且观察组血流灌注情况明显优于对照组，差异均有统计学意义（均P＜0.05）。术后30、60 d观察组左心室收缩末期内径、左心室舒张末期内径小于对照组，左心室射血分数大于对照组［术后30 d：（32±4）mm比（38±4）mm、（43±5）mm比（52±4）mm、（55±9）%比（52±9）%，术后60 d：（32±4）mm比（39±4）mm、（45±6）mm比（50±5）mm、（56±10）%比（51±10）%］，差异均有统计学意义（均P＜0.05）。随访3个月，观察组不良心血管事件发生率8.3%（3/36），明显低于对照组的30.6%（11/36），差异有统计学意义（P＜0.05）。结论 采用盐酸替罗非班辅助PCI治疗急性STEMI患者，可有效改善冠状动脉血流及心功能，降低术后不良心血管事件发生率。

Objective To explore the application value of tirofiban hydrochloride during percutaneous coronary intervention（PCI） for acute ST-segment elevation myocardial infarction（STEMI）. Methods A total of 72 patients with acute STEMI undergoing PCI from January 2014 to June 2015 in Jiaozhou Central Hospital of Qingdao in Shandong Province were randomly divided into observation group and control group, with 36 cases in each group. The observation group used tirofiban hydrochloride in PCI and the control group used 0.9% sodium chloride injection. Infarction related artery（IRA） blood flow, cardiac function indexes and the incidence of postoperative adverse cardiovascular events were analyzed. Results There was no significant difference of IRA blood flow between groups before PCI（P〉0.05）; the IRA blood flow in observation group after operation was significantly improved than that in control group（P〈0.05）. On 30, 60 d after PCI, left ventricular end systolic/diastolic diameters in observation group were significantly lower and left ventricular ejection fraction was significantly higher than those in control group[postoperative 30 d： （32±4）mm vs （38±4）mm, （43±5）mm vs （52±4）mm,（55±9）% vs （52±9）%; postoperative 60 d： （32±4）mm vs （39±4）mm, （45±6）mm vs （50±5）mm, （56±10）% vs （51±10）%]（P〈0.05）. The 3-month incidence of adverse cardiovascular events in observation group was significantly lower than that in control group[8.3%（3/36） vs 30.6%（11/36）]（P〈0.05）. Conclusion Application of tirofiban hydrochloride in PCI treating STEMI can effectively improve coronary blood flow and cardiac function and reduce the incidence of adverse events.