替罗非班对冠心病介入治疗后支架内血栓形成及炎性因子的影响

Effect of tirofiban on thrombosis and inflammatory factors of patients with coronary heart disease after percutaneous coronary intervention

目的:探讨替罗非班对冠心病经皮冠状动脉介入治疗(PCI)后支架内血栓形成及炎性因子的影响。方法:选择本院收治的冠心病患者110例,均行PCI术,根据不同的药物干预方式分为对照组和观察组各55例,对照组患者术前3 d口服阿司匹林肠溶片300 mg/次,1次/d;同时口服氯吡格雷片75 mg/次,1次/d。两组患者均行PCI术,术后患者长期服用阿司匹林100 mg/次,1次/d;同时给予氯吡格雷75 mg/次,1次/d,维持1年。观察组在对照组基础上联用替罗非班,术中对冠状动脉缓慢注射(10μg/kg),继之以0.15μg/(kg·min)静脉滴注维持36 h。比较两组术后支架内血栓形成情况;对术前及术后两组患者血清中白介素6(IL-6)、超敏C反应蛋白(Hs-CRP)、肿瘤坏死因子α(TNF-α)水平进行比较;观察两组不良反应情况;随访1年,观察两组生活质量情况。结果:治疗后观察组患者TIMI血流分级明显优于对照组(P<0.05);术前两组TNF-α、Hs-CRP和IL-6水平无明显差异(P>0.05),术后72 h两组患者TNF-α、Hs-CRP和IL-6水平比术前明显上升(P<0.05),观察组低于对照组(P<0.05);两组不良反应发生率无统计学意义(P>0.05);随访1年,观察组的生活质量水平优于对照组(P<0.05)。结论:对行PCI术的冠心病患者给予替罗非班治疗,可有效防止支架内血栓形成,并可有效减轻术后患者炎性反应,降低术后感染的风险,提高其生活质量水平。

Objective:To investigate the effect of tirofiban on thrombosis and inflammatory factors in patients with coronary artery disease after percutaneous coronary intervention(PCI).Methods:110 patients with coronary heart disease admitted to our hospital were enrolled in this study.All patients underwent PCI.According to the different drug interventions,these patients were divided into a control group and an observation group(n=55).Patients in the control group were treated with aspirin(300 mg/time,once a day)and clopidogrel(75 mg/time,once a day)preoperatively and postoperatively.On this basis,patients in the observation group received tirofiban in combination with the control group,and the coronary artery was slowly injected during surgery 10μg/kg,followed by 0.15μg/(kg·min)intravenous infusion maintained for 36 hours.The postoperative stent thrombosis was compared between the two groups.Serum levels of interleukin-6(IL-6),hypersensitive C-reactive protein(Hs-CRP),and tumor necrosis factorα(TNF-α)were compared between the two groups before and after surgery.The adverse reactions of the two groups were observed.The quality of life of the two groups was observed after a one-year follow-up.Results:After treatment,the TIMI blood flow grading in the observation group was significantly better than in the control group(P<0.05).There were no significant differences in TNF-α,Hs-CRP,and IL-6 levels between the two groups before surgery(P>0.05).The levels of TNF-α,Hs-CRP,and IL-6 between the two groups were significantly increased 72 hours after surgery(P<0.05),and the observation group was lower than the control group(P<0.05).There was no statistical significance in the incidence of adverse reactions between the two groups(P>0.05).After one year of follow-up,the quality of life in the observation group was better than that in the control group(P<0.05).Conclusions:Tirofiban therapy for coronary heart disease patients undergoing PCI can effectively prevent stent thrombosis,reduce postoperative inflammatory response,reduce the risk of postoperative infection,and improve their quality of life.