急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术联合应用盐酸替罗非班对心功能和血浆B型利钠肽的影响研究  

Effect of Tirofiban on the Heart Function and B-type Brain Natriuretic Peptide Level in Patients with ST-segmentelevation Myocardial Infarction Received Primary Percutaneous Coronary Intervention

作　　者：杨宇[1] 梁梅冰[2] 许顶立[1] 

机构地区：[1]南方医科大学南方医院心血管内科,广东省广州市510515 [2]广东医学院附属医院老年病科

出　　处：《中国全科医学》2014年第16期1866-1869,共4页Chinese General Practice

摘　　要：目的探讨盐酸替罗非班在急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入术(PCI)后对心功能及血浆B型利钠肽(BNP)的影响。方法选择2011年2月—2013年1月南方医科大学南方医院行直接PCI的急性STEMI患者104例,并采用简单随机抽样法将其平均分为观察组(52例)和对照组(52例)。观察组行直接PCI联合应用盐酸替罗非班治疗,对照组行直接PCI治疗。比较两组患者术后心肌再灌注指标〔病变血管心肌梗死溶栓治疗(TIMI)3级血流、心肌灌注(TMP)3级水平、90 min心电图ST段抬高总和回落百分比(sumSTR)〕;术后1、4周的心功能指标〔左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和左心室收缩末期内径(LVESD)〕;手术前后血浆BNP水平变化;术后3个月内主要心脏不良事件发生率。结果观察组术后TMP3级水平发生率和术后90 min心电图sumSTR>50%发生率高于对照组(P<0.05);而两组患者术后病变血管TIMI 3级血流发生率比较,差异无统计学意义(P>0.05)。组间比较显示,观察组术后1周LVEF高于对照组(P<0.05),两组术后4周LVEF、LVEDD、LVESD比较,差异均有统计学意义(P<0.05);组内比较显示,观察组术后4周LVEF、LVEDD与术后1周比较,差异有统计学意义(P<0.05);对照组术后4周LVEF、LVESD与术后1周比较,差异有统计学意义(P<0.05)。术前和术后1、4周两组患者血浆BNP水平比较,差异均有统计学意义(P<0.05)。组间比较显示,观察组术后1、4周血浆BNP水平低于对照组(P<0.05);组内比较显示,观察组术后4周血浆BNP水平低于术前和术后1周,术后1周血浆BNP水平低于术前(P<0.05);对照组术后1、4周血浆BNP水平低于术前(P<0.05)。术后3个月内观察组主要心脏不良事件发生率低于对照组〔7.7%(4/52)与23.1%(12/52),P<0.05〕。结论盐酸替罗非班能明显改善急性STEMI患者直接PCI后心功能,降低血浆BNP水平和主要心脏不良事件发生率,为临床应用提供参�Objective To evaluate the effect of tirofiban on the heart function and B -type brain natriuretic peptide （BNP） level in patients with ST- segmentelevation myocardial infarction （STEMI） who received primary percutaneous coronary intervention （PCI） . Methods From February 2011 to January 2013 one hundred and four patients of Nanfang Hospital, South- ern Medical University, with STEMI were randomly divided into observation group and control group, with 52 cases in each group. The observation group group was received tirofiban plus PCI and the control group was treated with PCI. TIMI grade 3, TMP grade 3 of myocardial perfusion, the resolution of the sum of ST - segment elevation （sumSTR） 90 minutes after the opera- tion, the serum BNP levels and heart function as well as major adverse cardiovascular events （MACE） were observed and com- pared between the two groups. Results The percentage of TMP 3 and sumSTR 〉 50% in the observation group were significantly higher than those of the control group （P 〈 0. 05 ）. There was no statistically significant difference of TIMI grade 3 between the two groups （ P 〉 0.05 ） , The level of LVEF of the observation group was significantly higher than that of the control group 1 week after operation （ P 〈 0.05 ） . There were significant differences of the levels of LVEF, LVEDD and LVESD 4 weeks after opera-tion between the two groups （ P 〈 0. 05 ） . Comparison results of within - group indicated that there were significant differences between LVEF, LVEDD 1 week after the operation and those 4 weeks after the operation in the observation group （P 〈0. 05）. The control group after 4 weeks LVEF, LVESD compared with after 1 week, the difference was statistically significant （ P 〈 0. 05 ） . There was significant difference in plasma BNP level between two groups before the operation, 1 week and 4 weeks after the operation （P 〈 0. 05） . The BNP levels of the observation group 1 and 4 weeks after operation were significantly lower

关 键 词：心肌梗死 盐酸替罗非班 心功能 利钠肽 脑 血管成形术 经腔 经皮冠状动脉 

分 类 号：R541.4[医药卫生—心血管疾病]