PCI术联合替罗非班对AMI患者TDR的影响及其预后的危险因素  

Influence of PCI combined tirofiban on TDR in AMI patients and risk factors for prognosis

作　　者：王楚林[1] 吴强[1] 徐名伟[1] 林宇鹏[1] 张华弟[1] 倪伟欣 徐衡[1] 刘琳琪 洪晓华[1] WANG Chu-lin;WU Qiang;XU Ming-wei;LIN Yu-peng;ZHANG Hua-di;NI Wei-xin;XU Heng;LIU Lin-qi;HONG Xiao-hua(CCU of Department of Cardiology,People′s Hospital of Jieyang City,Jieyang,Guangdong,522000,china)

机构地区：[1]揭阳市人民医院心内科CCU,广东揭阳522000

出　　处：《心血管康复医学杂志》2021年第1期51-56,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：揭阳市科技创新(卫生医疗)项目(2018wsyl016)。

摘　　要：目的:探讨PCI联合替罗非班对AMI患者跨室壁复极离散度(TDR)的影响及其预后的危险因素。方法:于我院行PCI术的160例AMI患者被随机均分为常规治疗组与替罗非班组(在常规治疗组基础上接受替罗非班)。观察比较两组术前及术后一个月T波峰-末间期(Tp-Te)、Tp-Te离散度(Tp-Ted),围术期及术后一个月LVESd、LVEDd、LVEF,随访1个月内主要不良心血管事件(MACE)发生率,并分析术后MACE发生的独立危险因素。结果:与常规治疗组比较,替罗非班组术后一个月Tp-Te[(117.29±17.58)ms比(111.79±11.71)ms]、Tp-Ted[(40.73±12.30)ms比(36.11±5.02)ms]、LVESd[(39.71±6.72)mm比(36.45±3.54)mm]、LVEDd[(46.09±6.47)mm比(44.20±4.41)mm]降低更显著,LVEF[(48.36±6.55)%比(51.61±4.50)%]升高更显著(P<0.05或<0.01)。随访一个月内,替罗非班组MACE发生率显著低于常规治疗组(18.8%比33.8%,P=0.031)。多因素Logistic回归分析结果显示,Killip心功能分级≥3级、年龄≥75岁、病变冠脉支数≥2支、发病至手术时间≥6h、糖尿病、冠心病家族史、吸烟、血脂异常均为影响患者预后的独立危险因素(OR=2.956~10.113,P均<0.01)。结论:PCI术联合替罗非班能显著降低AMI患者TDR,减轻心室重构,改善预后。Killip≥3级等多项指标为影响预后的独立危险因素。Objective:To explore influence of PCI combined tirofiban on transmural dispersion of repolarization(TDR)in AMI patients and risk factors for prognosis.Methods:A total of 160 AMI patients undergoing PCI in our hospital were randomly and equally divided into routine treatment group and tirofiban group(received tirofiban based on routine treatment group).T peak-T end interval(Tp-Te)and Tp-Te dispersion(Tp-Ted)before and one month after PCI,LVESd,LVEDd and LVEF during perioperative period and one month after PCI and incidence rate of MACE during one-month follow-up were observed and compared between two groups.And independent risk factors for MACE after PCI were analyzed.Results:Compared with routine treatment group on one month after PCI,there were significant reductions in Tp-Te[(117.29±17.58)ms vs.(111.79±11.71)ms],Tp-Ted[(40.73±12.30)ms vs.(36.11±5.02)ms],LVESd[(39.71±6.72)mm vs.(36.45±3.54)mm]and LVEDd[(46.09±6.47)mm vs.(44.20±4.41)mm],and significant rise in LVEF[(48.36±6.55)%vs.(51.61±4.50)%]in tirofiban group(P<0.05 or<0.01).During one-month follow-up,incidence rate of MACE in tirofiban group was significantly lower than that of routine treatment group(18.8%vs.33.8%,P=0.031).Multivariate Logistic regression analysis indicated that Killip cardiac function≥grade 3,age≥75 years,number of diseased coronary arteries≥2,onset-to-PCI time≥6h,diabetes mellitus,family history of coronary heart disease,smoking and dyslipidemia were independent risk factors for prognosis in AMI patients after PCI(OR=2.956~10.113,P<0.01 all).Conclusion:PCI combined tirofiban can significantly reduce TDR and ventricular remodeling,and improve prognosis in AMI patients.Killip cardiac etc.multiple indexes are independent risk factors for prognosis in AMI patients after PCI.

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 替罗非班 

分 类 号：R542.22[医药卫生—心血管疾病]