替罗非班对冠心病经皮冠状动脉介入术后患者的临床研究

Clinical trial of tirofiban on patients with coronary heart disease after percutaneous coronary intervention

目的观察替罗非班对冠心病患者经皮冠状动脉介入(PCI)术后的疗效。方法将进行PCI手术治疗的114例冠心病患者随机分为试验组57例和对照组57例。对照组术前及术后均服用阿司匹林300 mg·d^-1,阿托伐他汀钙40mg·d^-1,硫酸氢氯吡格雷片600 mg·d^-1。试验组术中向冠状动脉内注射替罗非班10μg·kg^-1,同时静脉推注替罗非班3 min,用量也为10μg·kg^-1,随后静脉持续泵入替罗非班24 h,速度为0.15μg·kg^-1·min^-1。2组均治疗3个月。比较2组患者炎性因子、血脂、血管内皮功能和药物不良反应发生情况。结果治疗后,试验组的心肌肌钙蛋白Ⅰ、肌酸激酶同工酶、超敏C反应蛋白、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、血管性假血友病因子、内皮素^-1、高密度脂蛋白胆固醇和一氧化氮分别为(0.14±0.09)μg·L^-1,(25.93±4.82)U·L^-1,(3.82±0.85)mg·L^-1,(3.62±0.42)mmol·L^-1,(1.23±0.72)mmol·L^-1,(2.41±0.24)mmol·L^-1,(102.48±22.17)%,(58.93±8.14)ng·L^-1,(1.73±0.69)mmol·L^-1,(83.05±11.31)mol·L^-1,对照组分别为(0.85±0.18)μg·L^-1,(71.31±9.17)U·L^-1,(6.11±0.46)mg·L^-1,(4.57±0.55)mmol·L^-1,(1.64±0.81)mmol·L^-1,(3.08±0.57)mmol·L^-1,(138.38±30.07)%,(81.26±15.27)ng·L^-1,(1.38±0.92)mmol·L^-1,(69.17±7.57)mol·L^-1,差异均有统计学意义(均P<0.05)。试验组的总药物不良反应发生率为22.81%(13例/57例),对照组为29.82%(17例/57例),差异无统计学意义(P>0.05)。结论对于进行PCI手术治疗的冠心病患者,阿托伐他汀钙联合硫酸氢氯吡格雷和替罗非班的综合用药方案具有良好的治疗效果,能够减少炎症损伤,改善血脂水平,提高血管内皮功能。

Objective To explore the clinical efficacy of tirofiban on patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 114 patients with coronary heart disease after PCI were randomly divided into treatment group(57 cases)and control group(57 cases).Before and after operation,control group was treated with aspirin 300 mg·d^-1,atorvastatin calcium 40 mg·d^-1,hydroclopidogrel sulfate 600 mg·d^-1.Treatment group was intravenously injected tirofiban 10μg·kg^-1 into the coronary artery,and tirofiban was injected intravenously for 3 min,and the dosage was also 10μg·kg^-1,then,tirofiban was continuously pumped intravenously for 24 h at a speed of 0.15μg·kg·min.After 3 months of treatment,the indexes were tested.The levels of inflammatory factors,blood lipids,vascular endothelial function and adverse drug reactions were compared between the two groups.Results After treatment,the levels of troponinⅠ,creatine kinase isoenzymes,high sensitivity C-reactive protein,total cholesterol,triglyeride,low density lipoprotein cholesterol,von willebrand factor,endothelin^-1,high density lipoprotein cholesterol and nitricoxide in treatment group were(0.14±0.09)μg·L^-1,(25.93±4.82)U·L^-1,(3.82±0.85)mg·L^-1,(3.62±0.42)mmol·L^-1,(1.23±0.72)mmol·L^-1,(2.41±0.24)mmol·L^-1,(102.48±22.17)%,(58.93±8.14)ng·L^-1,(1.73±0.69)mmol·L^-1,(83.05±11.31)mol·L^-1,all had significant differences with those in control group,which were(0.85±0.18)μg·L^-1,(71.31±9.17)U·L^-1,(6.11±0.46)mg·L^-1,(4.57±0.55)mmol·L^-1,(1.64±0.81)mmol·L^-1,(3.08±0.57)mmol·L^-1,(138.38±30.07)%,(81.26±15.27)ng·L^-1,(1.38±0.92)mmol·L^-1,(69.17±7.57)mol·L^-1(all P<0.05).The total incidence of adverse drug reactions in treatment group and control group were 22.81%(13 cases/57 cases)and 29.82%(17 cases/57 cases),without significant difference(P>0.05).Conclusion For patients with coronary heart disease undergoing PCI,the combination of atorvastatin calcium with clopidogrel sulfate and tirofiban has good clinical effects,which can reduce inflammatory injury,improve blood lipid and enhance vascular endothelial function.