替罗非班联合早期PCI治疗急性非ST段抬高型心肌梗死患者的临床疗效

Clinical efficacy of tirofiban combined with early PCI in the treatment of acute non-ST-segment elevation myocardial infarction

目的:探讨替罗非班联合早期PCI在急性非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者的疗效观察。方法:选择2017年5月至2018年5月沈阳医学院附属第二医院收治的NSTEMI高危且行早期PCI术患者80例为研究对象,随机分为治疗组和对照组,均于发病24 h内行PCI术。治疗组在PCI术前10～30min静脉注射替罗非班,对照组未给予替罗非班。观察2组患者PCI术前及术后梗死相关血管(IRA) TIMI分级,PCI术前及术后24 h心肌酶和肌钙蛋白含量,红细胞和血小板计数,术后1个月行心脏彩超检查,记录左室射血分数(LVEF)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)。观察术后1个月内出血并发症及主要不良心血管事件的发生情况。结果:治疗组和对照组术后TIMI 3级比例均增加(P<0.05);治疗组和对照组治疗后心肌酶和肌钙蛋白水平比较差异有统计学意义(P<0.05);治疗组和对照组治疗后红细胞及血小板计数均较治疗前降低,但差异无统计学意义(P>0.05);治疗组和对照组治疗后LVEDV、LVESV及LVEF差异有统计学意义(P<0.05);出院后随访1个月,2组患者总不良事件发生率差异无统计学意义(P>0.05)。结论:替罗非班联合早期介入治疗NSTEMI患者可以改善心肌微循环、减少心肌梗死面积、保护心脏机能,减少心血管事件的发生和改善预后生活质量。

Objective:To investigate the effect of tirofiban combined with early percutaneous coronary intervention(PCI)in the treatment of acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods:A total of 80 patients with NSTEMI who underwent early PCI within 24 h of symptom onset in our hospital from Jun 2017 to Jun 2018 were enrolled and were randomly devided into the treatment grouPand the control group.The treatment grouPreceived intravenous tirofiban at 10-30 mins before PCI,and the control grouPwere treated with PCI without preoperative intravenous tirofiban.The preoperative and postoperative infarctionrelated vascular(IRA)TIMI grading was performed in both groups.The myocardial enzyme and troponin levels,red blood cell and platelet counts were measured before and 24 h after PCI.Cardiac color ultrasonography was performed at 1 month after surgery,and left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),and left ventricular end-diastolic volume(LVEDV)were recorded.Hemorrhagic complications and major adverse cardiac events within 1 month after surgery were observed.Results:The proportion of TIMI 3 in both groups significantly increased after operation(P<0.05).After treatment,the difference of myocardial enzyme,troponin,LVEDV,LVESV and LVEF levels between the two groups were statistically significant(P<0.05).The red blood cell and platelet counts of the both groups after PCI were lower than those before treatment,but the difference was not statistically significant(P>0.05).Also there was no significant difference in the incidence of total adverse events between the two groups after 1 month of follow-uPafter discharge(P>0.05).Conclusions:Tirofiban combined with early PCI for NSTEMI can improve myocardial microcirculation,reduce myocardial necrosis,protect cardiac function,and improve quality of life.