不同治疗方案对急性ST抬高型心肌梗死患者PCI术后心功能及心肌微循环的影响

Effects of different therapeutic schemes on cardiac function and myocardial microcirculation in patients with acute ST elevation myocardial infarction after PCI

目的探讨不同治疗方案对急性ST抬高型心肌梗死患者PCI术后心功能及心肌微循环的影响。方法选取2013年1月至2015年12月收治急性ST抬高型心肌梗死患者91例,随机单盲取法将其分为A、B、C三组。A组给予常规+替罗非班治疗方案;B组在A组基础上,术后给予曲美他嗪治疗;C组在B组基础上,术前及术后给予丹参多酚酸盐治疗。观察三组治疗前及治疗7 d心功能及心肌微循环指标变化,同时观察三组术后3个月心血管不良事件及出血并发症情况。结果 C组治疗后左心室射血分数(LVEF)高于同组治疗前及A组、B组同期(P<0.05),左心室收缩末期内径(LVDs)、左心室舒张末期内径(LVDd)、左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)造影剂开始灌注时间(AT)、灌注达峰时间(APT)、灌注的峰值强度(PI)、振幅(A)、曲线上升斜率(β)低于同组治疗前及A组、B组同期同指标(P<0.05),B组治疗后LVEF高于同组治疗前及A组同期(P<0.05),LVDs、LVDd、LVESV、LVEDV、AT、APT、PI、A、β低于同组治疗前及A组同期同指标(P<0.05)。B组、C组心血管不良事件发生率低于A组(P<0.05),三组不同出血并发症程度及出血并发症发生率比较,差异无统计学意义(P>0.05)。结论与单纯替罗非班或加用曲美他嗪治疗方案相比较,替罗非班、尼可地尔及曲美他嗪联合应用于急性ST抬高型心肌梗死PCI术,可有效改善心功能,改善心肌微循环,不增加出血风险,值得临床推广应用。

Objective To investigate the effects of different therapeutic schemes on cardiac function and myocardial microcirculation in patients with acute ST elevation myocardial infarction after PCI,in order to provide data for clinical treatment. Methods From January 2013 ～2015 year in December 91 cases of patients with acute ST elevation myocardial infarction were randomly divided into A,B,C three group. A group received conventional treatment combined with tirofiban; group B based on group A,after treatment were given Sibutramine trimetazidine treatment; based on B group,C group were given preoperative and postoperative salvianolate treatment. The changes of cardiac function and myocardial microcirculation indexes were observed before and after treatment in three groups. The adverse cardiovascular events and bleeding complications ofthe three groups were observed at the same time after 3 months. Results The left ventricular ejection fraction（ LVEF） in C group was higher than that before treatment and A group,B group（ P〈0. 05）,left ventricular end systolic diameter（ LVDs）,left ventricular end diastolic diameter（ LVDd）,left ventricular end systolic volume（ LVESV）,left ventricular end diastolic volume（ LVEDV） angiography agent perfusion time（ AT）perfusion,peak time,peak intensity（ APT） perfusion（ PI）,amplitude（ A）,ascending slope（ SS） were lower than the same group before treatment and A group,B group with the same index（ P〈0. 05）,LVEF of B group after treatment was higher than that before treatment and A group（ P〈0. 05）,LVDs,LVDd,LVESV,LVEDV,AT,APT,PI,A,beta were lower than the same group before treatment and A group with the same index（ P〈0. 05）. The incidence of adverse cardiovascular events in group B and group A was lower than that in group C（ P〈0. 05）,and there was no significant difference between the three groups in the degree of bleeding complications and the incidence of bleeding complications（ P〈0. 05）. Conclusion Compared with tirofiban or with trimetazidine,the combination of Tirofiban,nicorandil and trimetazidine in acute ST elevation myocardial infarction PCI surgery can effectively improve heart function,improve myocardial microcirculation,increase the risk of bleeding,and it is worthy of clinical promotion.