急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗中冠脉内推注替罗非班行缺血预处理的有效性分析

Efficacy analysis of intracoronary injection of tirofiban for ischemic preconditioning in STEMI patients undergoing emergency PCI

目的 探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)中冠脉内推注替罗非班行缺血预处理的有效性和安全性。方法 选择2019年1月—2020年6月本院收治的142例STEMI且接受急诊PCI治疗的患者作为研究对象,按注射替罗非班行预处理方法不同分为处理A组(40例)、处理B组(42例)和对照组(60例)三组。处理A组采用在球囊扩张前先在冠脉内注射替罗非班预处理;处理B组采用在球囊扩张后在冠脉内注射替罗非班行预处理;对照组手术过程中未使用替罗非班。观察术中无复流、心律失常及术后心功能情况,对比术后6个月内全因性死亡以及心血管不良事件(MACE)发生情况。结果 处理A组与处理B组患者术后无复流率比较,差异无统计学意义(P>0.05);对照组患者术后无复流率明显高于处理A组和处理B组,差异具有统计学意义(P<0.05);三组患者在术中心律失常情况比较,差异无统计学意义(P>0.05);三组患者在术后心功能情况比较,差异无统计学意义(P>0.05);术后6个月内,三组患者在非心血管不良事件以及全因性死亡方面比较,差异无统计学意义(P>0.05);三组患者在恢复良好以及心血管不良事件(MACE)方面比较,差异具有统计学意义(P<0.05);其中两两比较,对照组患者在恢复良好方面的比例明显低于处理A组和处理B组,差异具有统计学意义(P<0.05);对照组患者在MACE事件方面的比例明显高于处理A组和处理B组,差异具有统计学意义(P<0.05);而处理A组与处理B组患者在恢复良好和MACE事件方面的比例比较,差异无统计学意义(P>0.05)。结论 STEMI患者急诊PCI中冠脉内推注替罗非班行缺血预处理,能显著减低术后无复流发生率以及减低术后6个月内患者MACE事件发生率。

Objective To investigate the efficacy and safety of intracoronary injection of tirofiban for ischemic preconditioning in patients with acute ST segment elevation myocardial infarction(STEMI)during emergency percutaneous coronary intervention(PCI).Methods Patients with STEMI who received emergency PCI in our hospital from January 1 st, 2019 to June 30 th, 2020 were included as research objects.According to different pre-process method of tirofiban injection, the patients were divided into three groups of A and B treatment group and control group, and there 40,42 and 60 cases in the three groups respectively.group A was pretreated by intracoronary injection of tirofiban before balloon dilatation;group B was pretreated by intracoronary injection of tirofiban after balloon dilatation;the control group did not use tirofiban during the operation.No-reflow, arrhythmia and postoperative cardiac function were observed, and all-cause death and major adverse cardiovascular events(MACE)within 6 months after operation were compared.Results The proportion of no-reflow in the control group was significantly higher than that in the treatment group A and B(P<0.05),however, there was no significant difference between the treatment group A and B(P>0.05).There was no significant difference in intraoperative arrhythmia and postoperative cardiac function among the three groups(P>0.05).there was no significant difference in non-cardiovascular adverse events and all-cause death within 6 months after operation among the three groups(P>0.05).In the perspective of good recovery and MACE,the difference was statistically significant(P<0.05).In pairwise comparison, the proportion of patients in the control group in good recovery was significantly lower than that in the treatment group A and B,and the difference was statistically significant(P<0.05).The proportion of MACE events in control group was significantly higher than that in treatment group A andtreatment group B,and the difference was statistically significant(P<0.05).There was no significant difference inthe proporPtion of patientns cwluitshio gnosod recovery and MACE events between the treatment group A and the treatmentgroup B(> 0. 05).Co In STEMI patients undergoing emergency PCI,intra-coronary injection oftirofiban for ischemic preconditioning could significantly reduce the incidence of no reflow and MACE within 6months after PCI.