替格瑞洛联合替罗非班对急诊PCI治疗急性ST段抬高型心肌梗死患者疗效观察  

Effect of Tirofiban in elderly patients with acute myocardial infarction complicated with diabetes mellitus undergoing percutaneous coronary intervention

作　　者：毋淑珍[1] 孙斌 卢革新[1] 耿银东[1] 姜辉 WU Shu-zhen;SUN Bin;LU Ge-xin;GENG Yin-dong;JIANG Hui(Department of Cardiology,The Second People Hospital of Zhengzhou,Zhengzhou 450000,China;不详)

机构地区：[1]郑州市第二人民医院心内科,郑州450000 [2]武警河南省总队医院疾控科,郑州450006

出　　处：《医药论坛杂志》2020年第10期49-53,共5页Journal of Medical Forum

摘　　要：目的观察替格瑞洛联合替罗非班对急性ST段抬高型心肌梗死患者急诊PCI术后心肌再灌注的作用及安全性。方法选取2013年4月-2018年6月于郑州市第二人民医院心内科行急诊PCI术的急性ST段抬高型心肌梗死患者(STEMI)300例,随机分为对照组140例及观察组160例。对照组病人给予阿司匹林+氯吡格雷+替罗非班治疗,观察组病人给予阿司匹林+替格瑞洛+替罗非班治疗。比较两组病人术后冠脉再灌注指标,术后2 h ST段回落﹥50%比例,术后6 h、12 h肌酸激酶同工酶(CK-MB),术后12 h血小板计数及血小板聚集率,可溶性CD40L(sCD40L)、基质金属蛋白酶-9(MMP-9),术后4周心功能(LVEF%),随访两组患者术后半年内主要不良心脏事件(MACE)及出血并发症发生情况。结果两组术后校正TIMI帧数(CTFC)较术前均有所改善,观察组改善程度显著优于对照组(P<0.05);观察组PCI术后梗死冠脉TIMI3级比例、术后2hST段回落﹥50%比例高于对照组[56/65(91.8%)VS 49/60(81.7%);55/65(76.9%)VS 35/60(58.3%),(P<0.05)];两组术后6 h及12 h CK-MB、术后12 h血小板计数及血小板聚集率比较有统计学差异(P<0.05);观察组术后12 h sCD40L、MMP-9水平低于对照组(100.45±25.82 VS 132.51±40.12;0.78±0.47 VS 1.24±0.85;P<0.05);术后1周、4周、6个月LVEF、RS、LS有统计学差异(P<0.05);术后半年内观察组MACE发生率显著低于对照组(P<0.05)。两组组消化道出血、皮肤黏膜出血、颅内出血等出血并发症差异无统计学意义(P>0.05)。结论替罗非班可有效改善老年DM-AMI患者PCI术后心肌再灌注,抑制炎症因子,改善心功能,降低术后不良心血管事件的发生。Objective To analyze the efficacy and safety of tirofiban in elderly patients with acute myocardial infarction(AMI) complicated with diabetes mellitus(DM) undergoing percutaneous coronary intervention(PCI).Methods One hundred and twenty-five elderly diabetic patients with acute myocardial infarction(DM-AMI) undergoing PCI from April 2013 to June 2018 in the Department of Cardiology in our hospital were randomly divided into twogroups:The control group(n=60)treated with routine treatment,and the treatment group(n=65)treated with routine treatment plus tirofiban.The corrected TIMI from countc(CTFC),the TIMI myocardial perfusion grade(TMPG),ST segment depression>50%,Creatine Kinase MB(CK-MB), platelet count and platelet aggregation rate,soluble CD40 L(sCD40 L), matrix metalloproteinase-9(MMP-9), left ventricular ejection fraction(LVEF%), Radial strain(RS) and longitudinal strain(LS) in the infarcted area, major adverse cardiac events(MACE)and bleeding complications were observed.Results After operation,CTFC was improved,which was better in treatment group than that in control group(P<0.05). The occurrence rate of TIMI grade 3 flow in treatment group was better than that in control group[56/65(91.8%)VS 49/60(81.7%)P<0.05]. There were statistically significant differences in ST segment depression>50%[55/65(76.9%)VS 35/60(58.3%),P<0.05)], There were significant differences in CK-MB at 6 h and12 h after operation, platelet countand and platelet aggregation rate at 12 hours after operation(P<0.05). sCD40 L and MMP-9 in the treatment group were lower than those in the control group. LVEF in the treatment group were higner at 1 week,4 weeks and 6 month after operation than that in control group(P<0.05).The incidence of MACE at six months after operation in treatment group was lower than that in control group(P<0.05).There was no significant difference in Bleeding complications between two groups(P>0.05).Conclusion Tirofiban plus routine treatment can improve myocardial damage and myocardial reperfusion,prevent coronary thr

关 键 词：糖尿病 急性心肌梗死 替罗非班 经皮冠状动脉介入治疗 校正TIMI帧数 

分 类 号：R541.4[医药卫生—心血管疾病] R58[医药卫生—内科学]