不同剂量盐酸替罗非班联合PCI对急性心肌梗死的临床疗效研究
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摘要
目的探讨不同剂量盐酸替罗非班联合经皮冠状动脉介入治疗(PCI)急性心肌梗死的临床疗效及安全性。方法 2015年3月至2018年1月于湖北省襄阳市解放军第四七七医院收治的90例急性心肌梗死患者,按照随机数字表法将分为观察组和对照组两组。观察组PCI中给予全剂量(0.15μg/kg·min)盐酸替罗非班治疗,对照组PCI中给予半剂量(0.075μg/kg·min)盐酸替罗非班治疗。比较两组患者术后TIMI心肌灌注(TMP)分级和梗死相关血管TIMI血流分级、血小板集聚率和血小板计数、心功能指标如左室舒张末期内径(LVEDD)和左室射血分数(LVEF)。同时采用酶联免疫吸附法测定两组患者治疗前后血清人可溶性CD40配体(s CD40L)和超敏C反应蛋白(hs-CRP)水平。PCI后随访半年,记录两组患者不良心血管事件发生情况包括心绞痛频繁发作、恶性心律失常、心肌再次梗死、急性心力衰竭、心源性休克等。结果观察组PCI后TMP分级、TIMI血流分级优于对照组(P<0.05)。两组治疗后血小板集聚率、血小板计数低于治疗前,且观察组治疗后血小板集聚率、血小板计数低于对照组(P<0.05)。两组治疗后LVEDD低于治疗前,LVEF高于治疗前,且观察组治疗后LVEDD低于对照组,LVEF高于对照组(P<0.05)。两组治疗后s CD40L、hs-CRP水平低于治疗前,且观察组治疗后s CD40L、hs-CRP水平低于对照组(P<0.05)。PCI后随访半年,两组不良心血管事件发生率无差异(P>0.05)。结论 PCI中全剂量盐酸替罗非班能有效改善患者术后心肌灌注,促进患者心功能恢复,抑制炎症反应而预防不良心血管事件发生。
Objective To discuss the clinical efficacy and safety of tirofiban hydrochloride in different doses combined with PCI on acute myocardial infarction(AMI). Methods AMI patients(n=90) were chosen from Chinese PLA the 477 th Hospital of Xiangyang City of Hubei Province from Mar. 2015 to Jan. 2018, and then divided randomly into observation group and control group. The observation group was treated with tirofiban hydrochloride in whole dose(0.15 μg/kg·min) and control group was treated with tirofiban hydrochloride in half dose(0.075 μg/kg·min)after PCI. The grading of myocardial perfusion(TMP) and TIMI flow grading of infarction-related vessels, platelet aggregation rate(PAR) and platelet count, heart function indexes including left ventricular end-diastolic inner diameter(LVEDd) and left ventricular ejection fraction(LVEF) were compared in 2 groups after PCI. The levels of human soluble CD40 ligand(sCD40 L) and high-sensitivity C-reactive protein(hs-CRP) were detected by using ELISA in 2 groups before and after treatment. The patients were followed up after PCI for half year, and major adverse cardiovascular events(MACE), including frequent attacks of angina pectoris, malignant arrhythmia, myocardial reinfarction, acute heart failure and cardiogenic shock were recorded in 2 groups. Results The post-PCI TMP grading and TIMI flow grading were better in observation group than those in control group(P<0.05). PAR and platelet count were lower in 2 groups after treatment, and they were lower in observation group than those in control group after treatment(P<0.05). LVEDd was lower and LVEF was higher in 2 groups after treatment, and LVEDd was lower and LVEF was higher n observation group than those in control group after treatment(P<0.05). The levels of sCD40 L and hs-CRP were lower in 2 groups after treatment and they were lower in observation group than those in control group after treatment(P<0.05). After followed up for half year, the incidence of MACE had no difference between 2 groups(P>0.05). Conclusion Tirofiban hydrochloride in whole dose can effectively improve myocardial perfusion and heart function, inhibit inflammatory reactions and prevent MACE during PCI.
Objective To discuss the clinical efficacy and safety of tirofiban hydrochloride in different doses combined with PCI on acute myocardial infarction(AMI). Methods AMI patients(n=90) were chosen from Chinese PLA the 477 th Hospital of Xiangyang City of Hubei Province from Mar. 2015 to Jan. 2018, and then divided randomly into observation group and control group. The observation group was treated with tirofiban hydrochloride in whole dose(0.15 μg/kg·min) and control group was treated with tirofiban hydrochloride in half dose(0.075 μg/kg·min)after PCI. The grading of myocardial perfusion(TMP) and TIMI flow grading of infarction-related vessels, platelet aggregation rate(PAR) and platelet count, heart function indexes including left ventricular end-diastolic inner diameter(LVEDd) and left ventricular ejection fraction(LVEF) were compared in 2 groups after PCI. The levels of human soluble CD40 ligand(sCD40 L) and high-sensitivity C-reactive protein(hs-CRP) were detected by using ELISA in 2 groups before and after treatment. The patients were followed up after PCI for half year, and major adverse cardiovascular events(MACE), including frequent attacks of angina pectoris, malignant arrhythmia, myocardial reinfarction, acute heart failure and cardiogenic shock were recorded in 2 groups. Results The post-PCI TMP grading and TIMI flow grading were better in observation group than those in control group(P<0.05). PAR and platelet count were lower in 2 groups after treatment, and they were lower in observation group than those in control group after treatment(P<0.05). LVEDd was lower and LVEF was higher in 2 groups after treatment, and LVEDd was lower and LVEF was higher n observation group than those in control group after treatment(P<0.05). The levels of sCD40 L and hs-CRP were lower in 2 groups after treatment and they were lower in observation group than those in control group after treatment(P<0.05). After followed up for half year, the incidence of MACE had no difference between 2 groups(P>0.05). Conclusion Tirofiban hydrochloride in whole dose can effectively improve myocardial perfusion and heart function, inhibit inflammatory reactions and prevent MACE during PCI.
引文
[1]Rabbani S,Soleimani M,Sahebjam M,et al.Simultaneous Delivery of Wharton's Jelly Mesenchymal Stem Cells and Insulin-Like Growth Factor-1in Acute Myocardial Infarction[J].Iran J Pharm Res,2018,17(2):426-41.
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[7]王桂芳,杨涛,郭彤,等.不同使用盐酸替罗非班方法对于ST段抬高性心肌梗死患者急诊经皮冠状动脉介入术后的影响[J].中国临床保健杂志,2015,18(6):633-6.
[8]Feng C,Han B,Liu Y,et al.Effect of nicorandil administration on m yocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction[J].Postepy Kardiol Interwencyjnej,2018,14(1):26-31.
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[10]Vdovin N,Gunther SPW,de Waha S,et al.Early Risk Stratification in Patients With Cardiogenic Shock Complicating Acute Myoc ardial Infarction Treated With Extracorporeal Life Support and Primary Percutaneous Coronary Intervention[J].JACC Cardiovasc Interv,2017,10(23):2469-71.
[11]肖艳,招煦杰.不同剂量替罗非班在急性心肌梗死患者PCI围术期应用的疗效和安全性[J].中国老年学杂志,2012,32(8):1576-8.
[12]Ndrepepa G,Neumann FJ,Deliargyris EN,et al.Bivalirudin versus heparin plus a glycoprotein IIb/IIIa inhibitor in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention after clopidogrel pretreatment:pooled analysis from the ACUITY and ISAR-REACT 4 trials[J].Circ Cardiovasc Interv,2012,5(5):705-12.
[13]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):1241-5.
[14]Tatlisu MA,Kaya A,Keskin M,et al.The association of the coronary thrombus burden with all-cause mortality and major cardiac events in ST-segment elevation myocardial infarction patients treated with tirofiban[J].Coron Artery Dis,2016,27(7):543-50.
[15]冯军鹏,王有恒,梁梅芳,等.替罗非班对急性心肌梗死患者经皮冠状动脉介入治疗术后支架内血栓形成的影响[J].海南医学,2013,24(2):174-5.
[16]王谨.不同剂量盐酸替罗非班联合PCI治疗对老年急性冠脉综合征合并糖尿病患者的有效性与安全性研究[J].中西医结合心血管病杂志,2015,3(1):10-2.
[17]Ji ZG,Liu HB,Liu ZH,et al.Influence of Tirofiban maintenance duration on patients with acute myocardial infarction treated by percutaneous coronary intervention[J].Chronic Dis Transl Med,2015,1(2):81-8.
[2]Jun SJ,Kim KH,Jeong MH,et al.Effects of Bisoprolol Are Comparable with Carvedilol in Secondary Prevention of Acute Myocardial Infarction in Patients Undergoing Percutaneous Coronary Intervention[J].Chonnam Med J,2018,54(2):121-8.
[3]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,2018,11(1A):73-5.
[4]龚肖丽,吕新湖,米杰,等.替罗非班对急性心肌梗死患者PCI术后血小板活化功能、TIMI血流分级及心肌梗死面积的影响[J].河北医药,2016,38(9):1330-2.
[5]任琳,王文广,王倩,等.半量替罗非班在老年急性心肌梗死急诊经皮冠状动脉介入治疗的疗效和安全性[J].中华老年心脑血管病杂志,2014,16(1):32-5.
[6]中国医师协会急诊医师分会,中国医学会心血管病学分会,中华医学会检验医学分会.急性冠脉综合征急诊快速诊疗指南[J].中华危重症医学杂志(电子版),2016,25(4):397-404.
[7]王桂芳,杨涛,郭彤,等.不同使用盐酸替罗非班方法对于ST段抬高性心肌梗死患者急诊经皮冠状动脉介入术后的影响[J].中国临床保健杂志,2015,18(6):633-6.
[8]Feng C,Han B,Liu Y,et al.Effect of nicorandil administration on m yocardial microcirculation during primary percutaneous coronary intervention in patients with acute myocardial infarction[J].Postepy Kardiol Interwencyjnej,2018,14(1):26-31.
[9]Russo JJ,Bagai A,Le May MR,et al.Immediate non-culprit vessel percutaneous coronary intervention(PCI)in patients with acutemyocardial infarction and cardiogenic shock:a swinging pendulum[J].J Thorac Dis,2018,10(2):661-6.
[10]Vdovin N,Gunther SPW,de Waha S,et al.Early Risk Stratification in Patients With Cardiogenic Shock Complicating Acute Myoc ardial Infarction Treated With Extracorporeal Life Support and Primary Percutaneous Coronary Intervention[J].JACC Cardiovasc Interv,2017,10(23):2469-71.
[11]肖艳,招煦杰.不同剂量替罗非班在急性心肌梗死患者PCI围术期应用的疗效和安全性[J].中国老年学杂志,2012,32(8):1576-8.
[12]Ndrepepa G,Neumann FJ,Deliargyris EN,et al.Bivalirudin versus heparin plus a glycoprotein IIb/IIIa inhibitor in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention after clopidogrel pretreatment:pooled analysis from the ACUITY and ISAR-REACT 4 trials[J].Circ Cardiovasc Interv,2012,5(5):705-12.
[13]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):1241-5.
[14]Tatlisu MA,Kaya A,Keskin M,et al.The association of the coronary thrombus burden with all-cause mortality and major cardiac events in ST-segment elevation myocardial infarction patients treated with tirofiban[J].Coron Artery Dis,2016,27(7):543-50.
[15]冯军鹏,王有恒,梁梅芳,等.替罗非班对急性心肌梗死患者经皮冠状动脉介入治疗术后支架内血栓形成的影响[J].海南医学,2013,24(2):174-5.
[16]王谨.不同剂量盐酸替罗非班联合PCI治疗对老年急性冠脉综合征合并糖尿病患者的有效性与安全性研究[J].中西医结合心血管病杂志,2015,3(1):10-2.
[17]Ji ZG,Liu HB,Liu ZH,et al.Influence of Tirofiban maintenance duration on patients with acute myocardial infarction treated by percutaneous coronary intervention[J].Chronic Dis Transl Med,2015,1(2):81-8.