摘要
目的:探讨替罗非班联合早期PCI在急性非ST段抬高型心肌梗死(non-ST-segment elevation myocardial infarction,NSTEMI)患者的疗效观察。方法:选择2017年5月至2018年5月沈阳医学院附属第二医院收治的NSTEMI高危且行早期PCI术患者80例为研究对象,随机分为治疗组和对照组,均于发病24 h内行PCI术。治疗组在PCI术前10～30min静脉注射替罗非班,对照组未给予替罗非班。观察2组患者PCI术前及术后梗死相关血管(IRA) TIMI分级,PCI术前及术后24 h心肌酶和肌钙蛋白含量,红细胞和血小板计数,术后1个月行心脏彩超检查,记录左室射血分数(LVEF)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)。观察术后1个月内出血并发症及主要不良心血管事件的发生情况。结果:治疗组和对照组术后TIMI 3级比例均增加(P<0.05);治疗组和对照组治疗后心肌酶和肌钙蛋白水平比较差异有统计学意义(P<0.05);治疗组和对照组治疗后红细胞及血小板计数均较治疗前降低,但差异无统计学意义(P>0.05);治疗组和对照组治疗后LVEDV、LVESV及LVEF差异有统计学意义(P<0.05);出院后随访1个月,2组患者总不良事件发生率差异无统计学意义(P>0.05)。结论:替罗非班联合早期介入治疗NSTEMI患者可以改善心肌微循环、减少心肌梗死面积、保护心脏机能,减少心血管事件的发生和改善预后生活质量。
Objective:To investigate the effect of tirofiban combined with early percutaneous coronary intervention(PCI)in the treatment of acute non-ST-segment elevation myocardial infarction(NSTEMI). Methods:A total of 80 patients with NSTEMI who underwent early PCI within 24 h of symptom onset in our hospital from Jun 2017 to Jun 2018 were enrolled and were randomly devided into the treatment group and the control group. The treatment group received intravenous tirofiban at 10-30 mins before PCI,and the control group were treated with PCI without preoperative intravenous tirofiban. The preoperative and postoperative infarction-related vascular(IRA)TIMI grading was performed in both groups. The myocardial enzyme and troponin levels,red blood cell and platelet counts were measured before and 24 h after PCI. Cardiac color ultrasonography was performed at 1 month after surgery,and left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),and left ventricular end-diastolic volume (LVEDV)were recorded. Hemorrhagic complications and major adverse cardiac events within 1 month after surgery were observed.Results:The proportion of TIMI 3 in both groups significantly increased after operation(P<0.05). After treatment,the difference of myocardial enzyme,troponin,LVEDV,LVESV and LVEF levels between the two groups were statistically significant(P<0.05). The red blood cell and platelet counts of the both groups after PCI were lower than those before treatment,but the difference was not statistically significant(P>0.05). Also there was no significant difference in the incidence of total adverse events between the two groups after 1 month of follow-up after discharge(P>0.05). Conclusions:Tirofiban combined with early PCI for NSTEMI can improve myocardial microcirculation,reduce myocardial necrosis,protect cardiac function,and improve quality of life.
引文
[1]梁文华,夏豪.急性非ST段抬高型心肌梗死早期介入与保守治疗效果及预后观察[J].临床误诊误治,2016,29(3):106-109.
[2]魏鹏,杨向军,付强,等.替罗非班治疗高危非ST段抬高急性冠脉综合征PCI术后患者的临床疗效[J].山东医药,2015,55(41):43-44.
[3]Li JP,Liu Q,Huo Y,et al.Rationale and design of the ETN-STEP(early administration of Tirofiban in mid to high risk patients with non-ST elevation acute coronary syndrome referred for percutaneous coronary intervention)project:a multi-center,randomized,controlled clinic trial in Chinese patients[J].J Geriatr Cardiol,2012,9(4):375-378.
[4]葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2014.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.非ST段抬高型急性冠状动脉综合征诊断和治疗指南(2016)[J].中华心血管病杂志,2017,45(5):359-376.
[6]王楚林,徐名伟,吴强,等.NSTE-ACS患者围手术期不同剂量替罗非班联合氯吡格雷强化治疗的应用[J].中国循证心血管医学杂志,2018,10(3):316-318.
[7]高华.非ST段抬高性心肌梗死及ST段抬高性心肌梗死患者的临床特征分析[J].中西医结合心血管病电子杂志,2016,4(2):16-17.
[8]朱静,邵正斌,戴小华,徐健.替罗非班在急性非ST段抬高型心肌梗死中的临床应用效果[J].临床合理用药杂志,2016,9(11):22-23.
[9]刘兴华,刘宗军.高危NSTE-ACS患者PCI术后应用替罗非班的临床研究[J].世界最新医学信息文摘,2017,17(34):1-2.
[10]温汝军,周靖雯,罗育鑫,等.替罗非班对急性非ST段抬高心肌梗死患者血清心肌肌钙蛋白T水平及近期预后的影响[J].海南医学,2017,28(23):3805-3807.
[11]李耀征.术前应用替罗非班对冠心病PCI患者的影响[J].现代临床医学,2018,44(4):277-278.2018-08-20
