血脂康联合替罗非班对急性心肌梗死患者高凝血状态、脂代谢及心肌血灌注的影响

Effects of Xuezhikang combined with tirofiban on hypercoagulability,lipid metabolism,and myocardial perfusion in patients with acute myocardial infarction

目的探讨血脂康联合替罗非班对急性心肌梗死(AMI)患者高凝血状态、脂代谢及心肌血灌注的影响。方法选取2017年6月至2019年6月间普宁华侨医院收治的200例AMI患者作为研究对象,采用随机数表法分为观察组和对照组,每组100例。两组患者均行经皮冠状动脉介入术(PCI)治疗,对照组患者术前予以替罗非班治疗,术后阿托伐他汀维持用药,观察组患者术前予以血脂康联合替罗非班治疗,术后血脂康维持用药。比较两组患者心肌灌注情况[心肌梗死溶栓试验(TIMI)]及凝血状态[凝血反应时间(R时间)、凝固时间(K时间)、凝固角(α角)、最大血块强度(MA值)],评估两组患者术后1周心脏功能恢复情况[心脏射血分数(LVEF)、左室舒张末期内径(LVEDD)],比较两组患者术后6个月脂代谢水平[总胆固醇(TC)、低密度脂蛋白(LDL-C)、三酰甘油(TG)],随访记录患者心脏主要不良事件(MACE)。结果术后TIMI试验显示,观察组患者的TIMIⅢ级达标率为95.00%,略高于对照组的91.00%,但差异无统计学意义(P>0.05);术后12 h,两组患者的R时间、K时间明显长于术前,差异均有统计学意义(P<0.05),而两组患者手术前后同期R时间、K时间、α角、MA值比较差异均无统计学意义(P>0.05);术后1周时,观察组患者的LVEF和LVEDD分别为(57.20±9.90)%、(46.11±3.63)mm,明显高于对照组的(53.10±10.43)%、(44.93±3.55)mm,差异均有统计学意义(P<0.05);治疗6个月后,两组患者的TC、LDL-C、TG水平明显低于治疗前,且观察组患者治疗后的TC、LDL-C、TG水平明显低于对照组,差异均有统计学意义(P<0.05);观察组患者的MACE总发生率为6.00%,略低于对照组的13.00%,但差异无统计学意义(P>0.05)。结论血脂康联合替罗非班能改善PCI术后AMI患者心脏功能和脂代谢,且不增加MACE发生风险。

Objective To explore the effects of Xuezhikang combined with tirofiban on hypercoagulability,lipid metabolism,and myocardial perfusion in patients with acute myocardial infarction(AMI).Methods A total of 200 patients with AMI who admitted to Puning Overseas Chinese Hospital between June 2017 and June 2019 were enrolled as the research subjects.They were divided into an observation group and a control group according to the random num ber table method,with 100 patients in each group.Based on percutaneous coronary intervention(PCI),patients in the control group were given tirofiban before surgery and atorvastatin maintenance medication after surgery,while those in the observation group were treated with Xuezhikang combined with tirofiban before surgery and given Xuezhikang maintenance medication after surgery.The myocardial perfusion[thrombolysis in myocardial infarction(TIMI)]and coagulation status[coagulation response time(R time),coagulation time(K time),coagulation angle(αangle),maximum clot strength(MA value)]were compared between the two groups.The cardiac function recovery status[left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)]were evaluated in the two groups at 1 week after surgery.The lipid metabolism indexes[total cholesterol(TC),low density lipoprotein-cholesterol(LDL-C),triacylglycerol(TG)]were compared between the two groups at 6 months after operation,and the major adverse cardiac events(MACE)were recorded by follow-up.Results Postoperative TIMI test showed that the TIMI gradeⅢcompliance rate was 95.00%in the observation group,slightly higher than 91.00%in the control group(P>0.05).At 12 h after surgery,the R time and K time of the two groups were significantly longer than those before surgery(P<0.05),and there were no statistically significant differences in the R time,K time,αangle,and MA value between the two groups before and after surgery(P>0.05).At 1 week after surgery,the LVEF and LVEDD were(57.20±9.90)%and(46.11±3.63)mm in the observation group,significantly higher than(53.10±10.43)%and(44.93±3.55)mm in the control group(P<0.05).After 6 months of treatment,the levels of TC,LDL-C,and TG in the two groups were significantly lower than those before treatment(P<0.05),and the levels of patients in the observation group after treatment were significantly lower than those in the control group(P<0.05).The total incidence rate of MACE was 6.00%in observation group,slightly lower than 13.00%in the control group(P>0.05).Conclusion Xuezhikang combined with tirofiban can improve cardiac function and lipid metabolism in patients with AMI after PCI without increasing the risk of MACE.