替罗非班注射剂治疗冠状动脉介入术后心肌梗死患者的临床研究

Clinical trial of tirofiban injection on patients with myocardial infarction after percutaneous coronary intervention

目的观察替罗非班注射剂对冠状动脉介入(PCI)术后心肌梗死患者的临床疗效。方法将本院进行PCI的心肌梗死患者60例,随机分为试验组和对照组,各30例。对照组给予单纯的冠状动脉介入手术治疗。试验组在对照组的基础上给予替罗非班注射剂,术中予以10μg·kg^-1负荷量静脉推注,术后给予0.15μg·kg-1·min-1持续泵入48 h。比较2组患者术后再灌注指标、心功能、凝血纤溶系统指标及药物不良反应发生情况。结果治疗后,试验组及对照组心肌梗死溶栓治疗(TIMI)3级分别为22例(73.33%)及28例(93.33%),ST段回落幅度分别为21例(70.00%)及27例(90.00%),差异有统计学意义(P<0.05)。试验组CK-MB峰值为(190.51±32.19)U·L^-1,明显低于对照组(261.54±71.04)U·L^-1(P<0.05)。试验组和对照组的纤维蛋白原分别为(3.14±0.21)和(3.87±0.23)g·L^-1,血友病因子分别为(89.72±8.73)%,(104.72±12.56)%,组织型纤溶酶原激活物分别为(0.37±0.06)和(0.31±0.04)U·mL^-1,抗凝血酶Ⅲ分别为(132.99±26.87)%,(118.84±14.88)%,纤溶酶原活化剂抑制物1分别为(43.86±5.21)和(49.87±4.23)U·mL^-1,差异均有统计学意义(均P<0.05)。试验组患者发生牙龈出血1例(3.3%);对照组发生出血事件3例(10.0%),其中牙龈出血1例,轻度消化道出血2例,差异有统计学意义(P<0.05)。结论替罗非班注射剂可改善PCI术后心肌梗死患者心功能,调节患者凝血纤溶系统,促进患者再次恢复灌注,降低出血事件发生率,安全可行,效果确切。

Objective To study the clinical effect of tirofiban injection on patients with myocardial infarction after percutaneous coronary intervention(PCI).Methods Sixty patients with myocardial infarction who underwent PCI in our hospital were randomly divided into treatment group and control group,with 30 patients in each group.Control group was treated with coronary intervention alone.Treatment group was treated with tirofiban injection on the basis of control group,10μg·kg^-1 load dose was given intravenously during the operation,and 0.15μg·kg^-1·min^-1 was administered postoperatively for 48 h.Postoperative reperfusion indicators,cardiac function,coagulation,fibrinolytic system indicator,and adverse drug reactions were compared between the two groups.Results After treatment,the thrombolysis in myocardial infarction(TIMI)grade 3 of treatment group and control group were 22 cases(73.33%)and 28 cases(93.33%),and the ST-segment fallback rates were 21 cases(70.00%)and 27 cases(90.00%),with significant difference(P<0.05).The peak value of CK-MB in treatment group was(190.51±32.19)U·L^-1,significantly lower than that in control group,which was(261.54±71.04)U·L^-1(P<0.05).The fibrinogen in treatment group and control group were(3.14±0.21),(3.87±0.23)g·L^-1,hemophilia factor were(89.72±8.73)%,(104.72±12.56)%,tissue-type plasminogen activator were(0.37±0.06),(0.31±0.04)U·mL^-1,antithrombinⅢwere(132.99±26.87)%,(118.84±14.88)%,plasminogen activator inhibitor were(43.86±5.21),(49.87±4.23)U·mL^-1,all with significant difference(all P<0.05).There was 1 case(3.3%)of gum bleeding in treatment group,and there were 3 cases(10.0%)of bleeding events in control group,including 1 case of gum bleeding and 2 cases of mild digestive tract bleeding,with significant difference(P<0.05).Conclusion Tirofiban injection can improve the cardiac function of patients with myocardial infarction after PCI,regulate the coagulation and fibrinolytic system of patients,promote patients to recover perfusion,reduce the incidence of bleeding event,safe and feasible,and the effect is accurate.