替罗非班给药方式对急性ST段抬高型心肌梗死PCI术后心功能和预后的影响  

Effect of different administration method of tirofiban on cardiac function and prognosis in acute ST segment elevation myocardial infarction after percutaneous coronary intervention

作　　者：孙朝阳[1] 李毅 刘莎 顾冰 SUN Zhao-yang;LI Yi;LIU Sha;GU Bing(Department of Cardiology Ankang Central Hospital,Ankang 725000, Shaanxi,CHINA;Department of Cardiovascular Medicine Ankang Central Hospital,Ankang 725000, Shaanxi,CHINA)

机构地区：[1]安康市中心医院心内科,陕西安康725000 [2]安康市中心医院心血管内科,陕西安康725000

出　　处：《海南医学》2018年第24期3408-3411,共4页Hainan Medical Journal

基　　金：陕西省自然科学基金(编号:2017JM8084)

摘　　要：目的对比替罗非班不同给药途径对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后心功能及预后的影响。方法选择安康市中心医院心内科于2017年1月至2018年2月期间收治的70例STEMI患者为研究对象,根据随机数表法将患者分为观察组(n=34)和对照组(n=36),所有患者均接受PCI及支架置入治疗,对照组予以静脉推注负荷剂量的替罗非班,观察组则冠脉内给药。比较两组患者术后梗死相关血管心肌梗死溶栓试验(TIMI)血流分级及心肌灌注分级(TMP),术后1周比较左室射血分数(LVEF)、左室舒张末内径(LVEDd)等心功能指标;记录术后血小板减少及出血情况;术后随访6个月,记录主要心血管不良事件(MACE)发生情况。结果 PCI术后,观察组患者的TMPG 2～3级的比例为94.12%,明显高于对照组的75.00%,差异有统计学意义(P<0.05);术后1周,观察组患者LVEF、LVEDd分别为(64.15±10.28)%、(50.04±6.31) mm,均明显优于对照组的(57.88±9.17)%、(53.18±5.36) mm,差异均有统计学意义(P<0.05);观察组与对照组患者出血发生率分别为11.76%和16.67%,差异无统计学意义(P>0.05);术后随访6个月,观察组患者MACE发生率为8.82%,明显低于对照组的25.00%,差异有统计学意义(P<0.05)。结论 STEMI患者行PCI术治疗应用替罗非班时,经冠状动脉内注射途径相对于静脉给药途径可以进一步改善患者心肌灌注及心功能,降低MACE发生率。Objective To compare the effects of different routes of administration of tirofiban on cardiac function and prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing percutaneous coronary intervention(PCI). Methods Seventy patients with STEMI treated in Department of Cardiology, Ankang Central Hospital from January 2017 to February 2018 were divided into observation group(n=34) and control group(n=36)according to the random number table. All patients received PCI and stent implantation. The control group received systemic loading dose of tirofiban, while the observation group received intracoronary administration. The thrombolysis inmyoxardial infarction trial(TIMI), blood flow grading, and myocardial perfusion grading(TMP) of infarction-related vessels were compared between the two groups, and the cardiac function indexes(including LVEF, LVEDd) were compared one week after operation. Follow-up of 6 months was performed to record the occurrence of major adverse cardiovascular events(MACE). Results After PCI, the proportion of TMPG 2-3 in observation group was 94.12%, which was significantly higher than 75.00% in control group(P<0.05). One week after PCI, the LVEF and LVEDd in observation group were(64.15±10.28)% and(50.04±6.31) mm, respectively, which were significantly better than(57.88±9.17)%and(53.18±5.36) mm in control group(P<0.05). There was no significant difference in the incidence of hemorrhage between the observation group and the control group(11.76% vs 16.67%, P>0.05). The MACE rate in the observation group(8.82%) was significantly lower than that in the control group(25.00%) after six months of follow-up(P<0.05).Conclusion Compared with intravenous infusion, intracoronary infusion of tirofiban can further improve myocardial perfusion and cardiac function and reduce the MACE rate in STEMI patients undergoing PCI.

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入术 替罗非班 心功能 预后 

分 类 号：R542.22[医药卫生—心血管疾病]