替罗非班联合重组人脑钠肽对急性心梗患者PCI术后心功能及心肌组织灌注的影响

Influence of tirofiban combined with recombinant human brain natriuretic peptide on heart function and myocardial perfusion in patients with acute myocardial infarction after PCI

目的探讨替罗非班联合重组人脑钠肽对急性心肌梗死(心梗)患者行经皮冠状动脉介入治疗PCI后心功能及心肌组织灌注的影响。方法将2017年1月至2019年6月于解放军陆军第81集团军医院急诊或住院治疗的急性心肌梗死行PCI后存活的160例患者,分为试验组和替罗非班组每组各80例。试验组给予常规治疗+PCI术+替罗非班联合重组人脑钠肽治疗;替罗非班组给予常规治疗+PCI术+替罗非班治疗。观察患者冠状动脉(冠脉)病变血管的分布、PCI术前后的冠脉血流速、心肌收缩功能(左室射血分数)、术中再灌注心律失常及不良反应等。应用SPSS 18.0软件对试验数据进行统计分析。结果在改善心功能及组织灌流方面,PCI手术联合替罗非班和重组人脑钠肽治疗,对改善冠脉血流速度、左室射血分数(心功能)的指标优于单纯的PCI手术联合替罗非班的治疗(P<0.05);对改善患者心率和预防术后的再灌注心律失常具有较好的疗效(P<0.05)。在对PCI术前、后冠脉的血流速度分级改善方面,PCI手术联合替罗非班和重组人脑钠肽的治疗,对改善冠脉病变远段血管的充盈效果较为显著(P<0.05)。在药物使用安全性方面,两组患者在治疗后的不良事件发生在两组间无统计学差异(P>0.05)。结论 PCI术联合替罗非班和重组人脑钠肽的治疗可较好地改善患者心功能和心肌组织灌注。

Objective To investigate the influence of tirofiban combined with recombinant human brain natriuretic peptide(rhBNP)on heart function and myocardial perfusion in patients with acute myocardial infarction(AMI)after PCI.Methods AMI patients undergone PCI and survived(n=160)were chosen from emergency and inpatient departments of Hospital of Chinese PLA 81 st Army Group from Jan.2017 to June 2019,and then divided into trial group and tirofiban group(each n=80).The trial group was treated with routine therapy+PCI+tirofiban combined with rhBNP,and tirofiban group was treated with routine therapy+PCI+tirofiban.The distribution of coronary artery lesions,coronary flow velocity before and after PCI,myocardial systolic function[right ventricular ejection fraction(RVEF)]and reperfusion arrhythmias during PCI were observed,and adverse reactions were recorded in 2 groups.The test data was given a statistical analysis by using SPSS 18.0 software.Results In term of improvement of heart function and tissue perfusion,the improvement effects on indexes of coronary flow velocity and RVEF were better in trial group than those in tirofiban group(P<0.05).The curative effect of improving heart rate and preventing post-operation reperfusion arrhythmias was better in trial group than those in tirofiban group(P<0.05).In term of improvement of coronary flow velocity grading before and after PCI,the effect of improving distal vessel filling was more significant in trial group than that tirofiban group(P<0.05).In term of safety of drugs,the incidence of adverse reactions had no statistical difference between 2 groups(P>0.05)after treatment.Conclusion PCI combined with tirofiban and rhBNP can signignificantly improve heart function and myocardial tissue perfusion in AMI patients.