替罗非班对介入治疗后ST段回落不良的急性心肌梗死患者预后的影响

Effect of Tirofiban on the Prognosis of Patients with Acute Myocardial Infarction with Poor ST-segment Regression after Interventional Therapy

目的:探究替罗非班对介入治疗后ST段回落(STR)不良的急性心肌梗死患者预后的影响。方法:选取2019年2月—2020年12月平顶山市第一人民医院收治的经皮冠状动脉介入术(PCI)治疗后的187例STR不良的急性心肌梗死患者作为研究对象,采用抽签法分为对照组93例与替罗非班组94例。对照组PCI术前未给予替罗非班,替罗非班组PCI术前给予替罗非班10μg/kg+静脉滴注0.15μg(kg·min),持续24 h。比较两组患者术前、术后ST抬高幅度及QRS碎裂波(f QRS)导联数,两组患者均随访30 d,比较两组患者治疗前、治疗后30 d左心室射血分数(LVEF),随访期间主要心脏不良事件及出血并发症情况。结果:术前,两组患者ST抬高幅度及fQRS导联数比较,差异无统计学意义(t=0.396、0.676,P>0.05),术后,替罗非班组ST抬高幅度为(1.37±0.42)mv、fQRS导联数为(2.27±0.67)个,均小于对照组的(3.76±0.84)mv、(2.27±0.67)mv,差异有统计学意义(t=24.568、15.291,P<0.05)。术前,两组患者LVEF比较,差异无统计学意义(t=0.242,P>0.05),术后30 d,替罗非班组LVEF为(55.76±4.20)%,高于对照组的(51.27±6.61)%,差异有统计学意义(t=5.537,P<0.05)。替罗非班组心脏不良事件发生率为6.38%、出血并发症发生率为3.19%,均显著低于对照组的16.13%、11.83%,差异有统计学意义(χ^(2)=4.454、5.034,P<0.05)。结论:替罗非班可改善PCI术后STR不良的急性心肌梗死患者ST抬高幅度、fQRS导联数及LVEF水平,降低患者术后心脏不良事件发生率与出血并发症发生率。

Objective:To investigate the effect of tirofiban on the prognosis of patients with acute myocardial infarction with poor ST-segment regression(STR)after interventional therapy.Methods:187 patients with poor STR acute myocardial infarction after percutaneous coronary intervention(PCI)treatment admitted to the hospital from February 2019 to December 2020 were selected for the study,and were divided into 93 cases in the control group and 94 cases in the tirofiban group using the lottery method.In the control group,no tirofiban was given before PCI,and in the tirofiban group,tirofiban 10μg/kg+0.15μg(kg.min)was given intravenously for 24 h before PCI.The amplitude of ST elevation and the number of QRS fragmentation wave(fQRS)leads before and after surgery were compared between the two groups.Both groups were followed up for 30 d.The left ventricular ejection fraction(LVEF)before and 30 d after treatment,major adverse cardiac events and bleeding complications during the follow-up period were compared between the two groups.Results:There was no statistically significant difference in the magnitude of ST elevation and the number of fQRS leads between the two groups before surgery(t=0.396,0.676,P>0.05).After surgery,the ST elevation in the tirofiban group was(1.37±0.42)mv and the number of f QRS leads was(2.27±0.67),which were smaller than(3.76±0.84)mv and(2.27±0.67)mv in the control group,with statistically significant differences(t=24.568,15.291,P<0.05).There was no statistically significant difference in LVEF between the two groups before surgery(t=0.242,P>0.05).At 30 d postoperatively,LVEF was(55.76±4.20)in the tirofiban group,which was higher than(51.27±6.61)%of the control group,with a statistically significant difference(t=5.537,P<0.05).The incidence of adverse cardiac events in the tirofiban group was 6.38%and the incidence of bleeding complications was 3.19%,which were significantly lower than 16.13%and 11.83%in the control group,with statistically significant differences(χ^(2)=4.454,5.034,P<0.05).Conclusion:Tirofiban improves ST elevation amplitude,fQRS lead count and LVEF levels in patients with acute myocardial infarction with poor ST-segment regression(STR)after PCI,and reduces the incidence of adverse cardiac events and bleeding complications in patients after the procedure.