替罗非班在急性ST段抬高型心肌梗死冠脉介入手术治疗中对血流动力学的影响
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摘要
目的探讨不同剂量替罗非班在急性ST段抬高型心肌梗死(STEMI)冠脉介入手术治疗中对血流动力学及术后心电图改变、胸痛缓解情况的影响。方法将2016年1月—2018年4月期间来我院接受治疗的80例STEMI患者选为观察对象,依照随机数字表法分为两组,即低剂量组(n=40)、标准剂量组(n=40)。低剂量组患者给予低剂量替罗非班(5μg/kg)治疗,标准剂量组患者给予标准剂量替罗非班(10μg/kg)治疗,对两组患者术后梗死相关血管(IRA)心肌梗死溶栓(TIMI)血流分级、主要心血管不良事件(MACE)、心电图ST段回落超50%比率、胸痛缓解率及出血分级情况进行统计比较。结果低剂量组患者与标准剂量组患者的TIMI血流分级、MACE发生率、心电图ST段回落比率超50%、胸痛缓解率比较,差异无统计学意义(P>0.05)。低剂量组患者出血率明显低于标准剂量组患者,且出血分级明显轻于标准剂量组患者,比较差异有统计学意义(P<0.05)。结论在STEMI冠脉介入手术治疗中,低剂量替罗非班与常规剂量替罗非班的治疗效果相当,而前者能够减少出血事件的发生,减轻出血分级,值得临床应用与推广。
Objective: To investigate the effects of different doses of tirofiban on hemodynamics and postoperative electrocardiogram changes and chest pain relief in patients with acute ST segment elevation myocardial infarction(STEMI) undergoing percutaneous coronary intervention. Methods: Eighyt cases of STEMI treated in our hospital from January 2016 to April2018 were selected as the observation subjects. According to the random number table,they were divided into two groups,namely,the low dose group(n = 40) and the standard dose group(n = 40). The low dose group were treated with low dose tirofiban(5 g/kg) treatment,the standard dose group was treated with standard dose tirofiban(10 g/kg). Statistical comparison of infarct related artery after operation in the two groups(IRA) thrombolysis in myocardial infarction(TIMI) flow classification,major adverse cardiovascular events(MACE) over 50%,the resolution of ST segment ratio,chest pain and bleeding rate of classification were made. Results: There was no significant difference in TIMI blood flow grade,MACE incidence and ST segment fall rate between the low dose group and the standard dose group(P > 0. 05). The difference between the two groups was not statistically significant(P > 50%). The bleeding rate of the low dose group was significantly lower than that of the standard dose group,and the bleeding grade was significantly lighter than that of the standard dose group. The difference was statistically significant(P < 0. 05). Conclusion: Low dose tirofiban is the same as regular dose of tirofiban in STEMI percutaneous coronary intervention,while the former can reduce the occurrence of bleeding events and reduce bleeding grades,which is worthy of clinical application and promotion.
Objective: To investigate the effects of different doses of tirofiban on hemodynamics and postoperative electrocardiogram changes and chest pain relief in patients with acute ST segment elevation myocardial infarction(STEMI) undergoing percutaneous coronary intervention. Methods: Eighyt cases of STEMI treated in our hospital from January 2016 to April2018 were selected as the observation subjects. According to the random number table,they were divided into two groups,namely,the low dose group(n = 40) and the standard dose group(n = 40). The low dose group were treated with low dose tirofiban(5 g/kg) treatment,the standard dose group was treated with standard dose tirofiban(10 g/kg). Statistical comparison of infarct related artery after operation in the two groups(IRA) thrombolysis in myocardial infarction(TIMI) flow classification,major adverse cardiovascular events(MACE) over 50%,the resolution of ST segment ratio,chest pain and bleeding rate of classification were made. Results: There was no significant difference in TIMI blood flow grade,MACE incidence and ST segment fall rate between the low dose group and the standard dose group(P > 0. 05). The difference between the two groups was not statistically significant(P > 50%). The bleeding rate of the low dose group was significantly lower than that of the standard dose group,and the bleeding grade was significantly lighter than that of the standard dose group. The difference was statistically significant(P < 0. 05). Conclusion: Low dose tirofiban is the same as regular dose of tirofiban in STEMI percutaneous coronary intervention,while the former can reduce the occurrence of bleeding events and reduce bleeding grades,which is worthy of clinical application and promotion.
引文
[1]李冀,夏碧桦,韩克跃.PCI术中替罗非班不同给药方式对急性心肌梗死患者术后心肌灌注及预后的影响[J].临床合理用药杂志,2018,11(1):73-75.
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[6]王学东,崔立强,鲁晶.冠状动脉内注射替罗非班治疗急性冠状动脉综合症介入治疗后无复流的临床研究[J].黑龙江医药,2017,30(6):1248-1249.
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[8]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.
[9]KAYMAZ C,KELES N,OZDEMIR N,et al.The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI[J].Anatolian J Cardiol,2015,15(11):899-906.
[10]蔡忠贵,王德启,李扬.替罗非班在急性心肌梗死行经皮冠状动脉介入术中的应用效果[J].实用临床医学,2016,17(7):15-17.
[11]TOPRAK C,TABAKCI M M,SIMSEK Z,et al.Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention[J].Postep Kardiol Inter,2015,11(4):288-297.
[12]王晓飞.老年急性ST段抬高性心肌梗死患者直接经皮冠状动脉介入治疗时应用高剂量国产替罗非班的疗效[J].黑龙江医药科学,2017(6):142-143.
[2]韩建旭,曾金美,马智会.替罗非班对PCI治疗的AMI患者血浆GDF-15及血清PAF的影响[J].心血管康复医学杂志,2017(6):651-655.
[3]雷肖蠢,邱军杰,王西辉.小剂量盐酸替罗非班联合急诊冠脉介入在心肌梗死患者中的临床效果及安全性[J].中国医学物理学杂志,2017,34(12):1241-1245.
[4]马威,黄琨,孙淑娴,等.不同风险等级STEMI患者急诊PCI应用比伐卢定与肝素+替罗非班的疗效与安全性比较[J].临床心血管病杂志,2017,33(12):1180-1185.
[5]张建坤,单微,张迎春,等.PCI术前给予替罗非班联合阿托伐他汀对急性心肌梗死患者外周血微RNA表达及血管内皮功能的影响[J].中国药房,2017,28(35):4952-4955.
[6]王学东,崔立强,鲁晶.冠状动脉内注射替罗非班治疗急性冠状动脉综合症介入治疗后无复流的临床研究[J].黑龙江医药,2017,30(6):1248-1249.
[7]IQBAL R,IQBAL S P,YAKUB M,et al.Major dietary patterns and risk of acute myocardial infarction in young,urban Pakistani popula-tion[J].Pak J Med Sci,2015,31(5):1213-1218.
[8]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.
[9]KAYMAZ C,KELES N,OZDEMIR N,et al.The effects of tirofiban infusion on clinical and angiographic outcomes of patients with STEMI undergoing primary PCI[J].Anatolian J Cardiol,2015,15(11):899-906.
[10]蔡忠贵,王德启,李扬.替罗非班在急性心肌梗死行经皮冠状动脉介入术中的应用效果[J].实用临床医学,2016,17(7):15-17.
[11]TOPRAK C,TABAKCI M M,SIMSEK Z,et al.Platelet/lymphocyte ratio was associated with impaired myocardial perfusion and both in-hospital and long-term adverse outcome in patients with ST-segment elevation acute myocardial infarction undergoing primary coronary intervention[J].Postep Kardiol Inter,2015,11(4):288-297.
[12]王晓飞.老年急性ST段抬高性心肌梗死患者直接经皮冠状动脉介入治疗时应用高剂量国产替罗非班的疗效[J].黑龙江医药科学,2017(6):142-143.