急诊经皮冠状动脉介入治疗术中应用血栓抽吸联合替罗非班治疗对炎性反应因子的影响
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摘要
目的探讨急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中应用血栓抽吸联合替罗非班的临床疗效及对炎性反应因子表达水平的影响。方法选取2015-04至2017-03收治的220例急性心肌梗死患者,按随机数字表法分为研究组和对照组,每组110例。对照组采用PCI治疗联合血栓抽吸。研究组PCI治疗联合血栓抽吸并在术前静脉滴注替罗非班。观察两组术后即刻冠状动脉血流情况(TIMI)变化。检测两组术前和术后24 h的CRP、IL-6、TNF-α、c Tn I、BNP水平。观察两组术后即刻心电图ST段回落≥50%发生率、术后LVEF、出院时Killip分级。结果术后即刻研究组TIMI血流分级明显优于对照组,差异有统计学意义(P <0. 05);术后24 h研究组CRP[(10. 17±1. 39) mg/L]、IL-6[(21. 85±2. 97) mg/L]、TNF-α[(41. 35±4. 70) ng/L]明显低于对照组的[(11. 64±1. 73) mg/L、(25. 01±3. 27) mg/L、(37. 96±3. 81)ng/L],差异有统计学意义(P <0. 05);术后24 h研究组c Tn I、BNP均低于对照组,差异有统计学意义(P <0. 05);研究组患者出院时心电图ST段回落≥50%发生率(65. 45%)、LVEF(56. 39±5. 13)、Killip分级均优于对照组,差异有统计学意义(P <0. 05)。结论替罗非班能进一步降低急诊血栓抽吸PCI患者炎性反应因子的分泌,减轻心肌细胞损伤,改善血流灌注状态。
Objective To investigate the clinical efficacy of thrombus aspiration combined with tirofiban in emergency percutaneous coronary intervention( PCI) and its effect on the expression of inflammatory factors in patients. Methods Two hundred and twenty patients with acute myocardial infarction were divided into the study group and the control group. The control group was treated with thrombus aspiration combined with PCI while the study group was additionally given intravenous drip of tirofiban. TIMI blood flow grading changes were detected in both groups. The levels of CRP,IL-6,TNF-α,c Tn I and BNP were detected in the two groups before and 24 hours after operation. Clinical outcome indexes of the two groups were observed: the incidence of immediate postoperative ST segment of electrocardiograms that decreased by more than 50%,postoperative LVEF,and Killip grade at discharge. Results The TIMI blood flow grade of the two groups improved significantly,especially in the control group. The difference was statistically significant( P < 0. 05). 24 hours after operation,the levels of CRP,IL-6 and TNF-alpha of the two groups decreased significantly. The difference was statistically significant( P < 0. 05). CRP( 10. 17 ± 1. 39) mg/L, IL-6( 21. 85 ± 2. 97) mg/L and TNF-alpha( 41. 35 ± 4. 70) ng/L in the study group were lower than those in the control group( 11. 64 ± 1. 73) mg/L,( 25. 01 ± 3. 27) mg/L,and37. 96 ± 3. 81) ng/L. 24 hours after operation,c Tn I and BNP of the two groups were significantly reduced,especially in the study group. The difference was statistically significant( P < 0. 05). The incidence of adverse cardiovascular events in the study group was lower than that in the control group. When the patients in the study group were discharged from hospital,the incidence of ST segment of electrocardiograms decreased by more than 50%( 65. 45%),while LVEF( 56. 39 ± 5. 13) and Killip grades were better than those in the control group( 50. 91% 、46. 72 ± 4. 05),the difference was statistically significant( P < 0. 05). Conclusions Tirofiban can further reduce the secretion of inflammatory factors,alleviate myocardial injury and improve blood flow perfusion in emergency PCI patients.
Objective To investigate the clinical efficacy of thrombus aspiration combined with tirofiban in emergency percutaneous coronary intervention( PCI) and its effect on the expression of inflammatory factors in patients. Methods Two hundred and twenty patients with acute myocardial infarction were divided into the study group and the control group. The control group was treated with thrombus aspiration combined with PCI while the study group was additionally given intravenous drip of tirofiban. TIMI blood flow grading changes were detected in both groups. The levels of CRP,IL-6,TNF-α,c Tn I and BNP were detected in the two groups before and 24 hours after operation. Clinical outcome indexes of the two groups were observed: the incidence of immediate postoperative ST segment of electrocardiograms that decreased by more than 50%,postoperative LVEF,and Killip grade at discharge. Results The TIMI blood flow grade of the two groups improved significantly,especially in the control group. The difference was statistically significant( P < 0. 05). 24 hours after operation,the levels of CRP,IL-6 and TNF-alpha of the two groups decreased significantly. The difference was statistically significant( P < 0. 05). CRP( 10. 17 ± 1. 39) mg/L, IL-6( 21. 85 ± 2. 97) mg/L and TNF-alpha( 41. 35 ± 4. 70) ng/L in the study group were lower than those in the control group( 11. 64 ± 1. 73) mg/L,( 25. 01 ± 3. 27) mg/L,and37. 96 ± 3. 81) ng/L. 24 hours after operation,c Tn I and BNP of the two groups were significantly reduced,especially in the study group. The difference was statistically significant( P < 0. 05). The incidence of adverse cardiovascular events in the study group was lower than that in the control group. When the patients in the study group were discharged from hospital,the incidence of ST segment of electrocardiograms decreased by more than 50%( 65. 45%),while LVEF( 56. 39 ± 5. 13) and Killip grades were better than those in the control group( 50. 91% 、46. 72 ± 4. 05),the difference was statistically significant( P < 0. 05). Conclusions Tirofiban can further reduce the secretion of inflammatory factors,alleviate myocardial injury and improve blood flow perfusion in emergency PCI patients.
引文
[1]俞泓,张蛟,贾小伟,等.血栓抽吸对急性STEMI患者PCI术后组织突出的影响[J].武警医学,2018,29(6):611-614.
[2]韩晓霞,刘秀红,周萍,等.ST段抬高型心肌梗死患者PCI血栓抽吸术后直接与延迟支架置入的疗效比较[J].海南医学院学报,2016,22(7):643-645.
[3]张小兵,杨帆,夏思良.血栓抽吸联合替罗非班在急性心肌梗死患者预后中的疗效评价[J].实用临床医药杂志,2017,21(5):110-112.
[4]中华医学会心血管病学分会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,16(12):710-725.
[5]Wang J L,Chen C C,Wang C Y,et al.Acute type a aortic dissection presenting as ST-Segment elevation myocardial infarction referred for primary percutaneous coronary intervention[J].Acta Cardiol Sin,2016;32(3):265-272.
[6]Zhang X L,Zhu Q Q,Yang J J,et al.Percutaneous intervention versus coronary artery bypass graft surgery in left main coronary artery stenosis:a systematic review and meta-analysis[J].BMC Med,2017;15(1):84.
[7]黄宇辉,许春平,曾波.急性心肌梗死介入治疗中血栓抽吸联合替罗非班的疗效分析[J].血栓与止血学,2017,23(4):577-579.
[8]张超红,代国方,王学惠.血栓抽吸与替罗非班对急性心肌梗死伴H型高血压行经皮冠状动脉介入术后的影响比较[J].安徽医药,2016,20(4):742-744.
[9]刘红娜,张悟棠.炎性反应因子与冠状动脉粥样硬化的关系及其在介入治疗后变化[J].中西医结合心脑血管病杂志,2016,14(8):848-852.
[10]周阳贞,李艳.急性心肌梗死患者PCI手术前后CRP、NT-proBNP、CK-MB、cTnT水平测定及临床意义[J].海南医学院学报,2016,22(13):1357-1360.
[11]李玉茹.血清CRP和IL-6水平对急性心肌梗死患者支架内血栓形成的预测价值[J].检验医学与临床,2017,14(17):2534-2536.
[12]陈运起,李海丽.急性心肌梗死患者hs-CRP、TNF-α及血钾、血钠水平对预后的影响[J].中西医结合心脑血管病杂志,2016,14(23):2733-2737.
[13]徐远胜,王宁夫.急性心肌梗死的生物标志物研究进展[J].心脑血管病防治,2017,17(4):297-299.
[14]Li L,Ge Z,Zhang D,et al.Efficacy and safety of quadruple therapy including tirofiban in the treatment of Chinese NSTE-ACS patients failing to receive timely percutaneous coronary intervention[J].Drug Des Devel T-her,2017,11:3299-3307.
[15]Lago I M,Novaes G C,Badran A V,et al.In-lab upfront use of tirofiban may reduce the occurrence of Noreflow during primary percutaneous coronary intervention[J].Arq Bras Cardiol,2016;107(5):403-410.
[2]韩晓霞,刘秀红,周萍,等.ST段抬高型心肌梗死患者PCI血栓抽吸术后直接与延迟支架置入的疗效比较[J].海南医学院学报,2016,22(7):643-645.
[3]张小兵,杨帆,夏思良.血栓抽吸联合替罗非班在急性心肌梗死患者预后中的疗效评价[J].实用临床医药杂志,2017,21(5):110-112.
[4]中华医学会心血管病学分会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,16(12):710-725.
[5]Wang J L,Chen C C,Wang C Y,et al.Acute type a aortic dissection presenting as ST-Segment elevation myocardial infarction referred for primary percutaneous coronary intervention[J].Acta Cardiol Sin,2016;32(3):265-272.
[6]Zhang X L,Zhu Q Q,Yang J J,et al.Percutaneous intervention versus coronary artery bypass graft surgery in left main coronary artery stenosis:a systematic review and meta-analysis[J].BMC Med,2017;15(1):84.
[7]黄宇辉,许春平,曾波.急性心肌梗死介入治疗中血栓抽吸联合替罗非班的疗效分析[J].血栓与止血学,2017,23(4):577-579.
[8]张超红,代国方,王学惠.血栓抽吸与替罗非班对急性心肌梗死伴H型高血压行经皮冠状动脉介入术后的影响比较[J].安徽医药,2016,20(4):742-744.
[9]刘红娜,张悟棠.炎性反应因子与冠状动脉粥样硬化的关系及其在介入治疗后变化[J].中西医结合心脑血管病杂志,2016,14(8):848-852.
[10]周阳贞,李艳.急性心肌梗死患者PCI手术前后CRP、NT-proBNP、CK-MB、cTnT水平测定及临床意义[J].海南医学院学报,2016,22(13):1357-1360.
[11]李玉茹.血清CRP和IL-6水平对急性心肌梗死患者支架内血栓形成的预测价值[J].检验医学与临床,2017,14(17):2534-2536.
[12]陈运起,李海丽.急性心肌梗死患者hs-CRP、TNF-α及血钾、血钠水平对预后的影响[J].中西医结合心脑血管病杂志,2016,14(23):2733-2737.
[13]徐远胜,王宁夫.急性心肌梗死的生物标志物研究进展[J].心脑血管病防治,2017,17(4):297-299.
[14]Li L,Ge Z,Zhang D,et al.Efficacy and safety of quadruple therapy including tirofiban in the treatment of Chinese NSTE-ACS patients failing to receive timely percutaneous coronary intervention[J].Drug Des Devel T-her,2017,11:3299-3307.
[15]Lago I M,Novaes G C,Badran A V,et al.In-lab upfront use of tirofiban may reduce the occurrence of Noreflow during primary percutaneous coronary intervention[J].Arq Bras Cardiol,2016;107(5):403-410.