替罗非班不同给药策略辅助PCI术对急性前壁心肌梗死患者心肌灌注水平、心电图改善情况及炎症因子水平的影响

Effects of Different Administration Strategies of Tirofiban Assisted PCI on Myocardial Perfusion Level,Electrocardiogram Performance and Inflammatory Factors in Patients with Acute Anterior Myocardial Infarction

【目的】探讨替罗非班不同给药策略辅助经皮冠状动脉介入治疗(PCI)术对急性前壁心肌梗死患者心肌灌注水平、心电图改善情况及炎症因子水平的影响。【方法】回顾性分析西安高新医院收治的96例急性前壁心肌梗死患者的临床资料,根据治疗方法的不同将其分为观察组和对照组,每组48例。两组患者均给予冠脉血栓抽吸+PCI,对照组静脉滴注替罗非班,观察组经冠状动脉内导管注射替罗非班。比较两组患者术后即刻心肌灌注水平、心电图表现(2 h内ST段回落幅度及Tp-e/QT)、不良反应及主要不良心脏事件(MACE)发生率,比较手术前后心肌损伤指标[肌酸磷酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)、脑钠肽(BNP)、乳酸脱氢酶(LDH)、肌酸激酶(CK)],炎症损伤指标[可溶性血管细胞间黏附分子-1(sVCAM-1)、可溶性CD40L(sCD40L)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)]。【结果】观察组术后即刻心肌灌注水平改善情况优于对照组,观察组2 h内ST段回落良好率高于对照组(P<0.05);两组治疗后Tp-e/QT值均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组血清CK-MB、cTnI、BNP、LDH、CK、sVCAM-1、sCD40L、CRP、TNF-α水平均低于治疗前,且观察组低于对照组(P<0.05)。两组患者不良反应及治疗后3个月MACE总发生率比较,差异无统计学意义(P>0.05)。【结论】经冠状动脉内导管注射替罗非班可显著改善经冠脉血栓抽吸+PCI术治疗的急性前壁心肌梗死患者心肌灌注水平,优化心电图表现,改善炎症因子水平,且安全性较好。

【Objective】To explore effects of different administration strategies of tirofiban assisted PCI(percutaneous coronary intervention)on postoperative myocardial perfusion level,electrocardiogram performance,the incidence of major adverse cardiovascular events(MACE)and inflammatory factors such as soluble vascular cell adhesion molecule-1(sVCAM-1)and platelet activating factor(PAF)in patients with of acute anterior myocardial infarction.【Methods】Clinical data of 96 patients with acute anterior myocardial infarction in Xi'an Gaoxin hospital were retrospectively analyzed and divided into the observation group and the control group by random number table,with 48 cases in each group.Both groups were given coronary thrombus aspiration and PCI.While the control group was given tirofiban intravenously and the observation group was given tirofiban catheter injection.Patients in the two groups were compared by myocardial perfusion level post-operation,ECG performance(ST-segment fall range and Tp-e/QT),adverse reactions and MACE incidence rates immediately after surgery,and myocardial injury indexes before and after surgery[creatine phosphokinase isoenzyme(CK-MB),troponin I(cTnI),brain natriuretic peptide(BNP),lactate dehydrogenase(LDH),creatine kinase(CK)],inflammatory injury indicators[sVCAM-1,soluble CD40L(sCD40L),C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)].【Results】The improvement of immediate myocardial perfusion in the observation group was better than that of the control group(P<0.05).The good rate of ST segment fall in the observation group within 2 hours was higher than that of the control group(P<0.05).The Tp-e/QT values of the two groups after treatment were lower than those before treatment;And value of Tp-e/QT in the observation group was lower than that in the control group(P<0.05).After treatment,CK-MB,cTnI,BNP,LDH,CK,sVCAM-1,sCD40L,CRP and TNF-αin the observation group were lower than those before treatment.And the levels of the observation group were lower than those of the control group(P<0.05).The difference in the total incidence of adverse reactions and MACE at 3 months after treatment in the two groups was not statistically significant(P>0.05).【Conclusion】Compared with tirofiban intravenous infusion,catheter injection of tirofiban can significantly improve myocardial perfusion in patients with coronary thrombus aspiration+PCI,optimize ECG performance and adjust sVCAM-1 and PAF levels,which has certain safety.