PCI联合替罗非班治疗对老年ACS合并糖尿病患者的疗效
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摘要
目的:探讨经皮冠状动脉介入(PCI)联合盐酸替罗非班治疗对老年急性冠脉综合征(ACS)合并糖尿病患者的疗效和安全性。方法:选择218例糖尿病合并ACS患者,被随机分为常规治疗组(107例,采用标准术式PCI治疗)和替罗非班组(111例,常规治疗组基础上给予冠脉替罗非班注射)。观察两组手术指标,以及住院期间出血事件、术后6个月内主要心血管不良事件(MACE)的发生率。结果:两组门球时间、支架置入数、支架置入长度等PCI手术指标相比较差异均无统计学意义(P均>0.05)。与常规治疗组比较,替罗非班组患者TIMI3级血流(75.70%比91.89%)、MBG2～3级(69.16%比85.56%)、术后90minST段回落>50%(77.57%比92.79%)比例均显著增加,校正TIMI帧数[(33.05±8.37)帧比(26.54±5.47)帧]显著减少(P均<0.01)。两组住院期间出血性事件发生率无显著差异(P=0.375)。替罗非班组6个月内MACE发生率显著低于常规治疗组(P=0.001)。结论:老年急性冠脉综合征患者在常规PCI治疗的基础上联合冠脉内注射替罗非班可显著改善术后心肌灌注水平,降低术后近期MACE的发生率,且未增加出血性事件发生率,安全性良好。
Objective:To explore therapeutic effect of percutaneous coronary intervention(PCI)combined hydrochloride tirofiban on aged patients with acute coronary syndrome(ACS)complicated diabetes mellitus(DM)and its safety.Methods:A total of 218 ACS+ DM patients were selected.According to randomization method,they were divided into routine treatment group(n=107,received standard PCI)and tirofiban group(n=111,received tirofiban injection in coronary artery based on routine treatment group).Operation indexes,incidence rates of hemorrhage during hospitalization and major adverse cardiovascular events(MACE)within six months after PCI were observed and compared between two groups.Results:There was no significant difference in door-to-balloon time,number and length of implanted stents between two groups,P>0.05 all.Compared with routine treatment group,there were significant rise in percentages of TIMI grade 3 blood flow(75.70% vs.91.89%),MBG grade 2～3(69.16% vs.85.56%)and ST segment regression>50% within 90 min after PCI(77.57% vs.92.79%),and significant reduction in corrected TIMI frame count(CTFC)[(33.05±8.37)frames vs.(26.54±5.47)frames]in tirofiban group,P<0.01 all.There was no significant difference in incidence rate of hemorrhage events during hospitalization between two groups,P=0.375.Incidence rate of MACE within six months in tirofiban group was significantly lower than that of routine treatment group,P=0.001.Conclusion:Intracoronary tirofiban injection based on routine PCI can significantly improve postoperative myocardial perfusion level,reduce incidence rate of short-term MACE after PCI without increasing incidence rate of hemorrhage in aged ACS patients.Its safety is good.
Objective:To explore therapeutic effect of percutaneous coronary intervention(PCI)combined hydrochloride tirofiban on aged patients with acute coronary syndrome(ACS)complicated diabetes mellitus(DM)and its safety.Methods:A total of 218 ACS+ DM patients were selected.According to randomization method,they were divided into routine treatment group(n=107,received standard PCI)and tirofiban group(n=111,received tirofiban injection in coronary artery based on routine treatment group).Operation indexes,incidence rates of hemorrhage during hospitalization and major adverse cardiovascular events(MACE)within six months after PCI were observed and compared between two groups.Results:There was no significant difference in door-to-balloon time,number and length of implanted stents between two groups,P>0.05 all.Compared with routine treatment group,there were significant rise in percentages of TIMI grade 3 blood flow(75.70% vs.91.89%),MBG grade 2～3(69.16% vs.85.56%)and ST segment regression>50% within 90 min after PCI(77.57% vs.92.79%),and significant reduction in corrected TIMI frame count(CTFC)[(33.05±8.37)frames vs.(26.54±5.47)frames]in tirofiban group,P<0.01 all.There was no significant difference in incidence rate of hemorrhage events during hospitalization between two groups,P=0.375.Incidence rate of MACE within six months in tirofiban group was significantly lower than that of routine treatment group,P=0.001.Conclusion:Intracoronary tirofiban injection based on routine PCI can significantly improve postoperative myocardial perfusion level,reduce incidence rate of short-term MACE after PCI without increasing incidence rate of hemorrhage in aged ACS patients.Its safety is good.
引文
[1]王品晓,张云霞,项晓觉,等.急性冠脉综合征患者血尿酸水平变化及与同型半胱氨酸、T细胞亚群、血脂的关系研究[J].中华全科医学,2017,15(9):1512-1514.
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[9]中华医学会心血管病学分会介入心脏病学组,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南2012(简本)[J].中华心血管病杂志,2012,40(4):271-277.
[10]徐伟豪,郭文杰.糖尿病对急性心肌梗死患者PCI术后远期生存的影响[J].解放军医药杂志,2017,29(3):57-61.
[11]陈涛,张春晓,米杰,等.冠心病合并糖尿病患者PCI术后支架内再狭窄相关因素分析[J].山东医药,2014,54(10):50-51.
[12]柳晓娜,朱宁,魏国峰,等.糖尿病合并急性冠脉综合征患者血小板表面PAC-1和CD62P表达水平[J].中国动脉硬化杂志,2015,23(2):161-164.
[13]杨玉辉,罗助荣,黄明方,等.合并糖尿病的冠心病患者PCI治疗后氯吡格雷抵抗的影响因素[J].岭南心血管病杂志,2014,20(3):285-289.
[14]谢昊,朱语眉,郝海平,等.糖尿病状态下阿司匹林抵抗的研究进展[J].中国临床药理与治疗学,2014,19(2):233-240.
[15]胡雅光,张会久,张志,等.替罗非班对糖尿病合并ST段抬高型急性心肌梗死患者经皮冠状动脉介入术后B型脑钠肽水平及心功能的影响[J].中国老年学杂志,2013,33(11):2499-2501.
[16]李慧娟,徐会圃.替罗非班对急诊PCI术后患者血清可溶性CD40配体、缺氧诱导因子α、诱导性一氧化氮合成酶的影响[J].实用医学杂志,2014,30(15):2481-2483.
[17]张庆华,闫华,赵国玉,等.替罗非班对糖尿病合并ST段抬高型心肌梗死PCI术后心肌灌注的影响[J].中国老年学杂志,2011,31(22):4354-4355.
[18]苏方华,许志勇,黎志忠.替罗非班等联合治疗急性冠脉综合征的出血并发症危险因素分析[J].中西医结合心脑血管病杂志,2016,14(5):542-544.
[19]吴迪.冠脉内注射替罗非班对老年急诊经皮冠状动脉介入术后心肌灌注及预后的影响[J].现代中西医结合杂志,2016,25(11):1186-1188.
[20]Balghith M,Al-Ghamdi A,Zainel H,et al.Intracoronary reopro during percutaneous coronary intervention in acute and stable patient can influence stent thrombosis formation(IR-PASST)study[J].Heart Views,2013,14(2):62-67.
[2]徐金军,郑萍.基因检测在急性冠脉综合征患者PCI术后个体化抗血小板治疗中的应用[J].中国药房,2017,28(23):3285-3289.
[3]胡菁,周全魁,谢艳丽.替罗非班联合氯吡格雷对老年急性冠脉综合征患者血小板功能、炎症因子及心功能的影响[J].中国老年学杂志,2017,37(5):1136-1138.
[4]李东戈,黄宇理,康品方,等.2型糖尿病合并急性冠脉综合征患者氯吡格雷抵抗及PCI术后不良预后分析[J].中国老年学杂志,2017,37(7):1637-1640.
[5]杨劲松,刘玉梅,杨海松,等.经皮冠状动脉介入联合替罗非班治疗急性ST段抬高型心肌梗死对患者心功能的影响[J].中国现代医学杂志,2015,25(28):74-77.
[6]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2013年版)[J].中华糖尿病杂志,2014,6(7):447-498.
[7]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.急性ST段抬高型心肌梗死诊断与治疗指南[J].中华心血管病杂志,2015,43(5):380-393.
[8]Amsterdam EA,Wenger NK,Brindis RG,et al.2014AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes:executive summary:a report of the american college of Cardiol/american herat association task fore on practice guidelines[J].J Am Coll Cardiol,2014,64(24):e139-e228.
[9]中华医学会心血管病学分会介入心脏病学组,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南2012(简本)[J].中华心血管病杂志,2012,40(4):271-277.
[10]徐伟豪,郭文杰.糖尿病对急性心肌梗死患者PCI术后远期生存的影响[J].解放军医药杂志,2017,29(3):57-61.
[11]陈涛,张春晓,米杰,等.冠心病合并糖尿病患者PCI术后支架内再狭窄相关因素分析[J].山东医药,2014,54(10):50-51.
[12]柳晓娜,朱宁,魏国峰,等.糖尿病合并急性冠脉综合征患者血小板表面PAC-1和CD62P表达水平[J].中国动脉硬化杂志,2015,23(2):161-164.
[13]杨玉辉,罗助荣,黄明方,等.合并糖尿病的冠心病患者PCI治疗后氯吡格雷抵抗的影响因素[J].岭南心血管病杂志,2014,20(3):285-289.
[14]谢昊,朱语眉,郝海平,等.糖尿病状态下阿司匹林抵抗的研究进展[J].中国临床药理与治疗学,2014,19(2):233-240.
[15]胡雅光,张会久,张志,等.替罗非班对糖尿病合并ST段抬高型急性心肌梗死患者经皮冠状动脉介入术后B型脑钠肽水平及心功能的影响[J].中国老年学杂志,2013,33(11):2499-2501.
[16]李慧娟,徐会圃.替罗非班对急诊PCI术后患者血清可溶性CD40配体、缺氧诱导因子α、诱导性一氧化氮合成酶的影响[J].实用医学杂志,2014,30(15):2481-2483.
[17]张庆华,闫华,赵国玉,等.替罗非班对糖尿病合并ST段抬高型心肌梗死PCI术后心肌灌注的影响[J].中国老年学杂志,2011,31(22):4354-4355.
[18]苏方华,许志勇,黎志忠.替罗非班等联合治疗急性冠脉综合征的出血并发症危险因素分析[J].中西医结合心脑血管病杂志,2016,14(5):542-544.
[19]吴迪.冠脉内注射替罗非班对老年急诊经皮冠状动脉介入术后心肌灌注及预后的影响[J].现代中西医结合杂志,2016,25(11):1186-1188.
[20]Balghith M,Al-Ghamdi A,Zainel H,et al.Intracoronary reopro during percutaneous coronary intervention in acute and stable patient can influence stent thrombosis formation(IR-PASST)study[J].Heart Views,2013,14(2):62-67.