不同剂量替罗非班对急诊经皮冠状动脉介入术急性ST段抬高型心肌梗死患者冠脉血流、心肌损伤的影响

Effects of Different Doses of Tirofiban on Coronary Blood Flow and Myocardial Injury in Patients with Acute ST Segment Elevation Myocardial Infarction after Emergency Percutaneous Coronary Intervention

目的:探究不同剂量替罗非班对急诊经皮冠状动脉介入术(PCI)急性ST段抬高型心肌梗死(STEMI)患者冠脉血流、心肌损伤的影响。方法:选取2018年1月~2020年1月本院收治的160例行急诊PCI术的STEMI患者作为研究对象,按照随机数字表法分为常规剂量组[术前注射替罗非班10μg/kg,术中至术后36h持续泵入0.15μg/(kg·min)]和半剂量组[术前注射替罗非班5μg/kg,术中至术后36h持续泵入0.075μg/(kg·min)],各80例。观察两组术后冠脉血流情况[术后即刻冠状动脉TIMI血流分级、TIMI心肌灌注分级(TMPG)、校正的TIMI帧数(CTFC)、慢血流(SCF)发生率及ST段回落率]、心肌损伤指标[肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、心型脂肪酸结合蛋白(hFABP)]术后峰值以及术后72h血清N末端B型利钠肽原(NT-proBNP)、D-二聚体表达水平,并统计两组住院期间出血事件及术后半年内主要心血管不良事件(MACE)。结果:术后,两组TIMI血流分级、TMPG分级、CTFC、SCF发生率及ST段回落率比较无统计学差异(P>0.05)。术后,两组心肌损伤指标cTnT、CK-MB、hFABP峰值比较无统计学差异(P>0.05)。术后72h,两组血清中NT-proBNP、D-二聚体表达水平均低于术前(P<0.05),但组间比较无统计学差异(P>0.05)。半剂量组出血率低于常规剂量组(P<0.05),两组MACE发生率比较无统计学差异(P>0.05)。结论:半剂量的替罗非班改善急诊PCI术STEMI患者冠脉血流及心肌损伤的效果与常规剂量相当,且可减少出血风险,安全性更高。

Objective:To investigate the effects of different doses of tirofiban on coronary blood flow and myocardial injury in patients with acute ST segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods:A total of 160 STEMI patients treated with emergency PCI from January 2018 to January 2020 in our hospital were selected as the research subjects.According to random number table method,they were divided into the conventional dose group[10μg/kg tirofiban was injected before operation,and 0.15μg/(kg·min)was pumped continuously from operation to 36 h after operation)and half dose group(5μg/kg tirofiban was injected before operation,and 0.075μg/(kg·min)was pumped continuously from operation to 36 h after operation],with 80 cases in each group.The postoperative coronary blood flow[immediate coronary TIMI blood flow grade,TIMI myocardial perfusion grade(TMPG),corrected TIMI frame count(CTFC),incidence of slow coronary flow(SCF)and ST segment fall rate],the postoperative peak value of myocardial injury markers[cardiac troponin T(cTnT),creatine kinase isoenzyme.