冠脉内注射替罗非班在急性心肌梗死患者急诊经皮冠状动脉介入治疗中的效果

Effect of intracoronary injection of Tirofiban on emergency percutaneous coronary intervention in patients with acute myocardial infarction

目的探讨冠脉内注射替罗非班在急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)中的临床效果。方法选取我院2015年1月~2017年1月收治的120例AMI患者,按随机数字表法分为对照组和观察组,各60例。对照组给予常规药物和PCI治疗,观察组在常规药物和PCI治疗的同时再给予10μg/kg替罗非班冠脉内注射,且术后以0.15μg/(kg·min)的量进行静脉维持。观察比较两组患者治疗前后的心肌梗死溶栓试验(TIMI)血流分级和CTFC数值变化,并比较两组术后左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)以及血浆BNP浓度。结果治疗前,两组的冠状动脉TIMI血流分级3级以上患者所占比例和CTFC比较,差异无统计学意义(P>0.05)。治疗后观察组冠状动脉TIMI血流分级3级以上患者所占比例高于对照组,而CTFC则低于对照组,差异均有统计学意义(P<0.05)。观察组手术3、15、30 d后的LVEF均高于对照组,LVEDD及LVESD则低于对照组,差异均有统计学意义(P<0.05)。观察组术后的血浆BNP浓度低于对照组,差异有统计学意义(P<0.05)。结论冠脉内注射替罗非班可明显改善AMI患者的心脏功能,效果显著且安全性较高,值得在临床上进行广泛推广应用。

Objective To investigate the clinical effect of intracoronary injection of Tirofibanon on emergency percutaneous coronary intervention（PCI） in patients with acute myocardial infarction（AMI）.Methods From January 2015 to January 2017,120 patients with AMI were selected and divided into the control group and the observation group according to the random number table method,60 cases in each group.The control group was treated with routine drugs and PCI.In the observation group,10 μg/kg Tirofiban injection was administered at the same time of routine medication and PCI,and the vein was maintained at 0.15 μg/（kg·min） after operation.The changes of blood flow classification and CTFC values in the two groups of patients with myocardial infarction thrombolytic test（TIMI） before and after treatment were compared.Left ventricular ejection fraction（LVEF）,left ventricular end-diastolic diameter（LVEDD）,left ventricular endsystolic diameter（LVESD） and plasma BNP concentration were compared between the two groups.Results Before treatment,there was no significant difference in the proportion of patients with TIMI grade 3 and CTFC between the two groups（P〉0.05）.After treatment,the proportion of patients with TIMI grade 3 or above in the observation group was higher than that in the control group,but the CTFC was lower than that in the control group（P〈0.05）.The LVEF at3,15,30 d after operation in the observation group was higher than that of the control group,while the LVEDD and LVESD were lower than the control group,and the differences were statistically significant（P〈0.05）.The plasma BNP concentration in the observation group was significantly lower than that in the control group（P〈0.05）.Conclusion Coronary artery injection of Tirofibanon can significantly improve heart function in patients with AMI,the effect is significant and safe,it is worth to be widely used in clinical practice.