替罗非班联合硝普钠对急性心肌梗死介入术后患者的影响

The effect of tirofiban combined with sodium nitroprusside on patients with acute myocardial infarction after interventional surgery

目的 探讨替罗非班联合硝普钠在急性心肌梗死(acute myocardial infarction,AMI)经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者中的效果。方法 回顾性分析2019年6月至2022年6月本院收治的行PCI的97例AMI患者的临床资料,根据PCI术中用药方案的不同将患者分成替罗非班组(n=48,替罗非班)和联合组(n=49,替罗非班联合硝普钠)。比较两组术后即刻血流改善情况、术后2 h ST段回落情况、术前后血清心肌肌钙蛋白(cardiac troponin,cTn)I水平、术前后心功能指标[左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)及左心室射血分数(left ventricular ejection fraction,LVEF)]及术后3个月内主要不良心脏事件(major adverse cardiac event,MACE)发生率。结果联合组血流改善率、ST段回落率分别为97.96%、95.92%,均明显高于替罗非班组的87.50%、83.33%(P <0.05);术后3d,两组血清cTnI水平均低于术前(P <0.05),且联合组明显较替罗非班组低(P <0.05);术后1个月,两组LVEDD均小于术前(P <0.05),LVEF均大于术前(P <0.05),且联合组上述心功能指标均明显较替罗非班组优(P <0.05);联合组MACE发生率4.08%,明显较替罗非班组的18.75%低(P <0.05)。结论 在AMI患者PCI术中联合应用替罗非班与硝普钠,可有效促进ST段回落及冠状动脉血流恢复,明显改善心功能,显著降低血清cTnI水平和MACE发生风险。

Objective To explore the effect of tirofiban combined with sodium nitroprusside in patients with acute myocardial infarction(AMI) undergoing percutaneous coronary intervention(PCI).Methods The clinical data of 97 patients with AMI who underwent PCI in our hospital from June 2019 to June 2022 were retrospectively analyzed,and the patients were divided into tirofiban group(n=48,tirofiban) and combination group(n=49,tirofiban combined with sodium nitroprusside) according to different medication regiments during PCI.Immediate postoperative blood flow improvement,ST segment regression at 2 h after surgery,serum cardiac troponin(cTn)I level before and after surgery,indexes of cardiac function before and after surgery[left ventricular end-diastolic diameter(LVEDD) and left ventricular ejection fraction(LVEF)] and the incidence of major adverse cardiac event(MACE) within 3 months after surgery were compared between the two groups.Results The blood flow improvement rate and ST segment regression rate in the combination group were 97.96% and 95.92%,respectively,which were obviously higher than those in the tirofiban group(87.50% and 83.33%)(P<0.05).On the 3rd day after operation,the level of serum cTnI in the two groups were lower than those before operation(P<0.05),and the combination group was obviously lower than the tirofiban group(P<0.05).One month after operation,the LVEDD in both groups were lower than those before operation(P<0.05),and the LVEF were higher than those before operation(P<0.05),and the above cardiac function indexes in the combination group were obviously better than those in the tirofiban group(P<0.05).The incidence of MACE in the combination group was obviously lower(4.08%)than that in the tirofiban group(18.75%)(P<0.05).Conclusion Combined application of tirofiban and sodium nitroprusside during PCI in patients with AMI can effectively promote ST segment regression and coronary blood flow recovery,obviously improve cardiac function,and significantly reduce serum cTnI level and the risk of MACE.