不同剂量替罗非班对急性ST段抬高型心肌梗死PCI患者心肌再灌注及心功能的影响

Effects of Different Doses of Tirofiban on Myocardial Reperfusion and Cardiac Function in Patients with Acute ST-segment Elevation Myocardial Infarction

目的:观察不同剂量替罗非班对急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)患者心肌再灌注及心功能的影响。方法:选取2019年3月-2020年3月120例于监利市中医医院就诊的急性STEMI患者,按随机数字表法分为A组、B组与C组,各40例。三组均采取PCI治疗,A组给予常规用药,B组在A组基础上给予替罗非班标准剂量(10μg/kg),C组在A组基础上给予替罗非班半剂量(5μg/kg)。比较三组血清肌酸激酶同工酶(CK-MB)峰值及峰值出现时间、心肌梗死溶栓试验(TIMI)3级血流与ST段回落>50%的占比、梗死相关血管无复流发生率、术后1周及术后4周的左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD),住院期间出血并发症发生率与1年随访期间主要不良心血管事件(MACE)发生率。结果:B组与C组的CK-MB峰值均低于A组,CK-MB峰值出现时间均早于A组,B组与C组ST段回落>50%占比均高于A组,梗死相关血管无复流发生率均低于A组(P<0.05)。B组与C组术后1周与术后4周的LVEF均高于A组,LVEDD与LVESD均低于A组(P<0.05)。A组随访期间MACE发生率显著高于B组与C组(P<0.05),B组与C组MACE发生率比较,差异无统计学意义(P>0.05)。B组出血并发症发生率高于A组与C组(P<0.05),A组与C组出血并发症发生率比较,差异无统计学意义(P>0.05)。结论:替罗非班可改善急性STEMI患者PCI后的远端栓塞和微循环,使心肌再灌注及心功能获得改善,并减少MACE发生,且半剂量的出血并发症发生率低于标准剂量。

Objective:To observe the effects of different doses of Tirofiban on myocardial reperfusion and cardiac function in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Method:A total of 120 patients with acute STEMI in Jianli Hospital of Traditional Chinese Medicine from March 2019 to March 2020 were randomly divided into group A,group B and group C,with 40 cases in each group.All three groups were treated with PCI,group A received conventional medication,group B received standard dose(10μg/kg)of Tirofiban based on group A,group C received half dose(5μg/kg)of Tirofiban based on group A.The peak and peak appearance time of creatine phosphate enzyme isozyme(CK-MB),the proportion of thrombolysis in myocardial infarction(TIMI)grade 3 blood flow and ST segment fall>50%,the incidence of no reflow in infarct-related vessels,left ventricular ejection fraction(LVEF),left ventricular end diastolic endocele(LVEDD)and left ventricular end-systolic diameter(LVESD)at 1 week postoperatively and 4 weeks postoperatively,the incidence of bleeding complications during hospitalization and the incidence of major adverse cardiac events(MACE)during 1-year follow-up were compared among three groups.Result:The peak values of CK-MB in group B and group C were lower than that in group A,the time of peak value of CK-MB in group B and group C were earlier than that in group A,the proportions of ST-segment regression>50%in group B and group C were higher than that in group A,and the incidences of no reflow in infarct-related vessels were lower than that in group A(P<0.05).LVEF,LVEDD and LVESD in group B and C were higher than those in group A at 1 week and 4 weeks after surgery(P<0.05).During the follow-up period,the incidence of MACE in group A was significantly higher than those in group B and group C(P<0.05),but there was no statistical significance in the incidence of MACE between group B and group C(P>0.05).The incidence of bleeding complications in group B was higher than those in group A and group C(P<0.05),but there was no statistical significance in the incidence of bleeding complications between group A and group C(P>0.05).Conclusion:Tirofiban can improve distal embolization and microcirculation in patients with acute STEMI,improve myocardial reperfusion and cardiac function,and reduce MACE events,and the half-dose bleeding complication rate is lower than the standard dose.