替罗非班联合氯吡格雷治疗急性心肌梗死的疗效观察

Efficacy observation of tirofiban combined with clopidogrel in the treatment of acute myocardial infarction

目的观察替罗非班联合氯吡格雷治疗急性心肌梗死的疗效。方法160例急性心肌梗死患者,采用随机数字表法分为试验组和参考组,每组80例。参考组给予氯吡格雷治疗,试验组给予替罗非班联合氯吡格雷治疗。对比两组患者的临床效果及治疗前后心功能指标(左室射血分数、左室收缩末期内径和左室舒张末期内径)、血管内皮功能指标(血浆内皮素-1、一氧化氮)。结果试验组的临床总有效率为93.75%,高于参考组的81.25%,差异具有统计学意义(P<0.05)。治疗前,试验组的左室射血分数为(37.14±0.65)%,左室收缩末期内径为(59.95±3.25)mm,左室舒张末期内径为(46.70±0.38)mm,与参考组的(37.16±0.68)%、(59.93±3.21)mm、(46.68±0.41)mm比较,差异无统计学意义(P>0.05)。治疗后,试验组的左室射血分数为(55.33±0.42)%,左室收缩末期内径为(41.05±2.01)mm,左室舒张末期内径为(35.83±1.64)mm;参考组的左室射血分数为(42.06±0.57)%,左室收缩末期内径为(53.27±2.29)mm,左室舒张末期内径为(42.77±1.68)mm;两组患者的左室射血分数、左室收缩末期内径和左室舒张末期内径均较本组治疗前改善,且试验组左室射血分数高于参考组,左室收缩末期内径和左室舒张末期内径小于参考组,差异具有统计学意义(P<0.05)。治疗前,试验组的血浆内皮素-1为(76.42±3.97)ng/L,一氧化氮为(49.78±4.62)μmol/L,与参考组的(76.45±3.99)ng/L、(49.74±4.58)μmol/L比较,差异无统计学意义(P>0.05)。治疗后,试验组的血浆内皮素-1为(54.57±3.24)ng/L,一氧化氮为(80.09±5.12)μmol/L;参考组的血浆内皮素-1为(63.27±5.71)ng/L,一氧化氮为(68.39±5.04)μmol/L;两组患者血浆内皮素-1、一氧化氮均较本组治疗前改善,且试验组血浆内皮素-1水平低于参考组,一氧化氮水平高于参考组,差异具有统计学意义(P<0.05)。结论替罗非班联合氯吡格雷治疗急性心肌梗死的临床效果良好,能够改善患者的心功能和血管内皮功能,进而缓解临床症状。

Objective To observe the efficacy of tirofiban combined with clopidogrel in the treatment of acute myocardial infarction.Methods A total of 160 patients with acute myocardial infarction were divided into experimental group and reference group by random numerical table,with 80 cases in each group.The reference group was treated with clopidogrel,and the experimental group was treated with tirofiban combined with clopidogrel.Both groups were compared in terms of clinical effects,cardiac function indexes(left ventricular ejection fraction,left ventricular end-systolic diameter and left ventricular end-diastolic diameter),and vascular endothelial function indexes(plasma endothelin-1,nitric oxide)before and after treatment.Results The total clinical effective rate of the experimental group was 93.75%,which was higher than 81.25%of the reference group,and the difference was statistically significant(P<0.05).Before treatment,the left ventricular ejection fraction of the experimental group was(37.14±0.65)%,the left ventricular end-systolic diameter was(59.95±3.25)mm,and the left ventricular end-diastolic diameter was(46.70±0.38)mm,and the differences were not statistically significant compared with(37.16±0.68)%,(59.93±3.21)mm and(46.68±0.41)mm of the reference group(P>0.05).After treatment,the left ventricular ejection fraction of the experimental group was(55.33±0.42)%,the left ventricular end-systolic diameter was(41.05±2.01)mm,and the left ventricular end-diastolic diameter was(35.83±1.64)mm;the left ventricular ejection fraction of the reference group was(42.06±0.57)%,the left ventricular end-systolic diameter was(53.27±2.29)mm,and the left ventricular end-diastolic diameter was(42.77±1.68)mm.The left ventricular ejection fraction,left ventricular end-systolic diameter and left ventricular end-diastolic diameter of the two groups were improved compared with those of this group before treatment;the left ventricular ejection fraction of the experimental group was higher than that of the reference group,and the left ventricular end-systolic diameter and left ventricular end-diastolic diameter were smaller than those of the reference group;all the differences were statistically significant(P<0.05).Before treatment,the plasma endothelin-1 of the experimental group was(76.42±3.97)ng/L,and the nitric oxide was(49.78±4.62)μmol/L,and the differences were not statistically significant compared with(76.45±3.99)ng/L,(49.74±4.58)μmol/L of the reference group(P>0.05).After treatment,the plasma endothelin-1 in the experimental group was(54.57±3.24)ng/L,and the nitric oxide was(80.09±5.12)μmol/L;the plasma endothelin-1 of the reference group was(63.27±5.71)ng/L,and the nitric oxide was(68.39±5.04)μmol/L.The plasma endothelin-1 and nitric oxide in the two groups were improved compared with those before treatment in this group;the plasma endothelin-1level of the experimental group was lower than that of the reference group,and the level of nitric oxide was higher than that of the reference group;all the differences were statistically significant(P<0.05).Conclusion Tirofiban combined with clopidogrel has a good clinical effect in the treatment of acute myocardial infarction.It can improve the cardiac function and vascular endothelial function,thereby relieving clinical symptoms.