PCI联合盐酸替罗非班对老年ASTEMI患者的疗效及对心功能和心肌微循环的影响  

Therapeutic effect of PCI combined tirofiban hydrochloride on aged ASTEMI patients and its influence on cardiac function and myocardial microcirculation indexes

作　　者：王庆旭 李德才[1] 张大勇 胡波 陈涛 周致远 刘朝晖 唐焕君[1] 杨艳 胡腾 邸云峰 WANG Qing-xu;LI De-cai;ZHANG Da-yong;HU Bo;CHEN Tao;ZHOU Zhi-yuan;LIU Chao-hui;TANG Huan-jun;YANG Yan;HU Teng;DI Yun-feng(Department of Cardiology,404 Hospital of Mianyang,Mianyang,Sichuan,621000,China)

机构地区：[1]四川绵阳四〇四医院心内科,四川绵阳621000

出　　处：《心血管康复医学杂志》2018年第2期174-178,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨经皮冠状动脉介入治疗(PCI)联合盐酸替罗非班对老年急性ST段抬高型心肌梗死(ASTEMI)患者的疗效及对心功能和心肌微循环指标的影响。方法:选择2013年7月~2016年3月在我院行PCI治疗的ASTEMI老年患者90例。按照入院顺序,患者被随机均分为单纯PCI组和联合治疗组(在单纯PCI组治疗基础上加用替罗非班),两组均治疗1个月。测量比较两组术后ST段回落幅度、校正TIMI帧数(CTFC)、TIMI血流分级,术前及术后的心肌微循环内造影剂声学峰值强度(PI)和血清CK-MB峰值浓度,术前及术后6个月的LVEF、LVEDd和LVEDV,以及不良事件发生率。结果:与单纯PCI组比较,术后2h联合治疗组ST段回落幅度[(43.8±7.1)%比(66.2±8.2)%]、TIMI血流分级[(2.1±0.5)级比(2.9±0.6)级]和PI[(7.1±1.1)比(8.6±1.2)]显著升高,CTFC[(27.3±8.0)帧比(18.9±6.6)帧]、血清CK-MB峰值水平[(296.5±58.1)U/L比(199.3±32.4)U/L]均显著降低(P均=0.001)。与单纯PCI组比较,术后6个月联合治疗组LVEF[(54.2±8.3)%比(61.1±8.0)%]显著升高,LVEDd[(48.1±7.7)mm比(41.3±8.1)mm]和LVEDV[(85.4±10.6)mm^3比(80.2±10.4)mm^3]均显著降低(P<0.05或<0.01)。联合治疗组的总不良事件发生率显著低于单纯PCI组(8.89%比26.67%),P=0.027。结论:PCI联合盐酸替罗非班可显著改善心肌微循环、心脏功能,且心血管不良事件发生率低,其机制可能与盐酸替罗非班改善心肌微循环的作用有关。Objective:To explore therapeutic effect of percutaneous coronary intervention(PCI)combined tirofiban hydrochloride on aged patients with acute ST elevation myocardial infarction(ASTEMI)and its influence on cardiac function and myocardial microcirculation.Methods:A total of 90 aged ASTEMI patients undergoing PCI in our hospital from Jul 2013 to Mar 2016 were selected.According to hospitalization order,they were randomly and equally divided into pure PCI group and combined treatment group(received tirofiban based on pure PCI group),both groups were treated for one month.ST segment regression degree,corrected TIMI frame count(CTFC)and TIMI flow grade after PCI,contrast agent acoustic peak intensity in myocardial microcirculation(PI)and serum CK-MB peak concentration before and after PCI,LVEF,LVEDd and LVEDV before and six months after PCI,and incidence rate of adverse events were measured and compared between two groups.Results:Compared with pure PCI group after PCI,there were significant rise in ST segment regression degree[(43.8±7.1)%vs.(66.2±8.2)%],TIMI flow grade[(2.1±0.5)grade vs.(2.9±0.6)grade]and PI[(7.1±1.1)vs.(8.6±1.2)],and significant reductions in CTFC[(27.3±8.0)frame vs.(18.9±6.6)frame],and serum CK-MB peak level[(296.5±58.1)U/L vs.(199.3±32.4)U/L]in combined treatment group,P=0.001 all.Compared with pure PCI group on six months after PCI,there was significant rise in LVEF[(54.2±8.3)%vs.(61.1±8.0)%],and significant reductions in LVEDd[(48.1±7.7)mm vs.(41.3±8.1)mm]and LVEDV[(85.4±10.6)mm 3 vs.(80.2±10.4)mm 3]in combined treatment group,P<0.05 or<0.01.Total incidence rate of adverse events of combined treatment group was significantly lower than that of pure PCI group(8.89%vs.26.67%),P=0.001.Conclusion:PCI combined tirofiban hydrochloride can significantly improve myocardial microcirculation and cardiac function with low incidence rate of cardiovascular adverse events.The mechanism may be related to improving effect of tirofiban hydrochloride on myocardial microcirculation.

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 微循环 

分 类 号：R542.22[医药卫生—心血管疾病]