硝酸甘油联合替罗非班对急性心肌梗死PCI术后TIMI血流分级、心功能和血清hs-CRP水平的影响

Effect of glyceryl trinitrate combined with tirofiban on TIMI blood flow classification,cardiac function,and serum hs-CRP levels in patients with acute myocardial infarction after percutaneous coronary intervention

目的探讨硝酸甘油联合替罗非班对急性心肌梗死经皮冠状动脉介入术(PCI)后心肌梗死溶栓试验(TIMI)血流分级、心功能和血清高敏C反应蛋白(hs-CRP)水平的影响。方法选择2018年5月至2020年6月在贺州市人民医院行PCI术的90例急性ST段抬高性心肌梗死患者为研究对象,按照治疗方式的不同将患者分为观察组和对照组各45例。对照组患者术中采用替罗非班治疗,观察组患者术中采用硝酸甘油联合替罗非班治疗。比较两组患者术后即刻TIMI血流分级、住院期间及随访6个月时左室射血分数(LVEF)、左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD),以及术前和术后7 d的血清hs-CRP水平,并比较两组患者术后6个月的不良心血管事件及不良反应发生情况。结果观察组患者术后TIMI血流分级良好率为88.89%,明显高于对照组的71.11%,差异有统计学意义(P<0.05);住院期间,两组患者的LVEF、LVESD、LVEDD比较差异均无统计学意义(P>0.05),而随访6个月时,两组患者的LVEF均明显升高,且观察组患者LVEF为(57.49±5.61)%,明显高于对照组的(53.22±5.75)%,两组患者的LVESD、LVEDD均明显降低,且观察组的LVESD、LVEDD分别为(38.96±3.81)mm、(40.20±4.75)mm,明显低于对照组的(43.11±4.07)mm、(46.52±4.64)mm,差异均有统计学意义(P<0.05);术前,两组患者的血清hs-CRP水平比较差异无统计学意义(P>0.05),术后7 d时,两组患者的血清hs-CRP水平均明显降低,且观察组患者的血清hs-CRP为(4.28±0.64)mg/L,明显低于对照组的(5.07±0.55)mg/L,差异均有统计学意义(P<0.05);观察组和对照组患者术后6个月不良心血管事件总发生率分别为11.11%和15.56%,并发症总发生率分别为11.11%和8.89%,差异均无统计学意义(P>0.05)。结论硝酸甘油联合替罗非班治疗可有效改善急性心肌梗死患者PCI术后的TIMI血流分级、心功能,降低血清hs-CRP水平,且安全性好。

Objective To study the effect of glyceryl trinitrate combined with tirofiban on thrombolytic test for myocardial infarction(TIMI)blood flow classification,cardiac function,and serum high sensitivity C-reactive protein(hs-CRP)levels in patients with acute myocardial infarction after percutaneous coronary intervention(PCI).Methods A total of 90 patients with acute ST segment elevation myocardial infarction who underwent PCI in Hezhou People's Hospital from May 2018 to June 2020 were selected for this study.According to different treatment methods,they were divided into an observation group and a control group,with 45 patients in each group.The control group was treated with tirofiban,while the observation group was treated with glyceryl trinitrate combined with tirofiban.The TIMI blood flow grading immediately after operation,the changes of the left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),left ventricular end diastolic diameter(LVEDD)during hospitalization and at 6 months of follow-up,and serum hs-CRP levels before and at 7 d after operation,and the incidence of adverse cardiovascular events and adverse reactions at 6 months after operation were compared.Results The good rate of TIMI blood flow grading in the observation group was 88.89%,which was significantly higher than 71.11%in the control group(P<0.05).During hospitalization,there were no significant differences in LVEF,LVESD,and LVEDD between the two groups(P>0.05);at 6 months of follow-up,the LVEF in two groups were significantly increased,and the LVEF in the observation group was(57.49±5.61)%,which was significantly higher than(53.22±5.75)%of the control group;at 6 months of follow-up,the LVESD and LVEDD in two groups were significantly reduced,and the LVESD and LVEDD in the observation group were(38.96±3.81)mm and(40.20±4.75)mm,which were significantly lower than(43.11±4.07)mm and(46.52±4.645)mm of the control group;the differences were statistically significant(P<0.05).Before operation,there was no significant difference in serum hs-CRP level between the two groups(P>0.05);at 7 d after operation,the serum hs-CRP levels in two groups were decreased significantly,and the serum hs-CRP in the observation group was(4.28±0.64)mg/L,which was significantly lower than(5.07±0.55)mg/L of the control group(P<0.05).The total incidence of adverse cardiovascular events at 6 months after operation was 11.11%in the observation group and 15.56%in the control group,and the total incidence of adverse reactions was 11.11%and 8.89%,which showed no statistically significant difference between the two groups(P>0.05).Conclusion Glyceryl trinitrate combined with tirofiban can effectively improve TIMI blood flow grading and cardiac function in patients with acute myocardial infarction after PCI,and reduce serum hs-CRP levels,with good safety,which is worthy of clinical application.