急诊经皮冠状动脉介入术治疗的急性心肌梗死患者围术期联合使用替罗非班、阿司匹林和氯吡格雷的疗效和安全性

Efficacy and safety of perioperative combined therapy of tirofiban,aspirin and clopidogrel in patients with acute myocardial infarction undergoing emergency percutaneous coronary intervention

目的探讨急诊经皮冠状动脉介入术(PCI)治疗的急性心肌梗死(AMI)患者围术期联合使用替罗非班、阿司匹林及氯吡格雷的疗效和安全性。方法将90例行急诊PCI治疗的AMI患者随机分为观察组50例和对照组40例。PCI前后,两组患者均使用阿司匹林、氯吡格雷治疗,观察组同时联用替罗非班治疗。比较两组PCI后心肌梗死溶栓治疗(TIMI)血流分级、TIMI心肌灌注(TMP)分级、PCI前后左室射血分数(LVEF)、左室舒张末期内径(LVEDD)和血小板相关指标,以及围术期心血管不良事件、出血相关不良事件的发生情况。结果PCI后,观察组TIMI血流分级Ⅲ级、TMP分级Ⅲ级的患者比例均高于对照组(均P<0.05)。PCI后半年,两组LVEF、LVEDD较围手术期改善(P<0.05),且观察组LVEF高于对照组,LVEDD低于对照组(均P<0.05)。两组PCI后血小板分布宽度、血小板平均体积均较术前下降,且观察组低于对照组(P<0.05)。围术期观察组心血管不良事件发生率低于对照组(P<0.05),但两组出血相关不良事件发生率差异无统计学意义(P>0.05)。结论在传统阿司匹林及氯吡格雷二联抗血小板聚集治疗的基础上,联合替罗非班可更有效地改善行急诊PCI治疗的AMI患者的心肌灌注和心脏功能,减少心脏不良事件的发生率,且不增加出血相关并发症的发生。

Objective To investigate the efficacy and safety of perioperative combined therapy of tirofiban,aspirin and clopidogrel in patients with acute myocardial infarction(AMI) undergoing emergency percutaneous coronary intervention(PCI).Methods Ninety patients with AMI undergoing emergency PCI were randomly divided into observation group( n =50) and control group( n =40).Before and after PCI,patients in the two groups were treated with aspirin and clopidogrel,concomitantly,the observation group was given combined clopidogrel therapy.The two groups were compared in items of post-PCI thrombolysis in myocardial infarction(TIMI) blood flow grading,TIMI myocardial perfusion(TMP) grading,pre- and post-PCI left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD) and platelet-related indicators,as well as the incidence of perioperative cardiovascular adverse events and bleeding-related adverse events.Results After PCI,the proportion of patients with TIMI blood flow grade Ⅲ or TMP grade Ⅲ in the observation group was higher than that in the control group(all P <0.05).Six months after PCI,LVEF and LVEDD were improved in both groups compared with the perioperative ones( P <0.05),and the observation group exhibited higher LVEF and lower LVEDD than the control group(all P <0.05).After PCI,platelet distribution width(PDW) and mean platelet volume(MPV) were decreased in both groups in contrast to the preoperative ones( P <0.05),and the levels in the observation group were lower than those in the control group( P <0.05).The observation group had a lower incidence rate of perioperative cardiovascular adverse events than the control group( P <0.05),but there was no statistically significant difference in incidence rate of bleeding-related adverse events between the two groups( P >0.05).Conclusion Based on traditional combined therapy of aspirin and clopidogrel against platelet aggregation,combined use of tirofiban can improve myocardial perfusion and cardiac function more effectively and reduce the incidence rate of adverse cardiac events in patients with AMI undergoing emergency PCI,not increasing the incidence of bleeding-related complications.