低分子肝素联合替罗非班在急性非Q波心肌梗死患者急救治疗中的应用及预后分析  

Analyses on effect of applying low molecular weight heparin combined with Tirofiban in emergency treatment of patients with acute non-Q wave myocardial infarction and prognosis

作　　者：杨蓉[1] 严首春 李寅珍 Yang Rong;Yan Shouchun;Li Yinzhen(Dpartment of Fundamental Medicine,Hubei College of Chinese Medicine,Jingzhou 434020,Hubei,China;Shaanxi University of Chinese Medicine,Xianyang 712046,Shaanxi,China;Department of Neurology,the Second People’s Hospital of Three Gorges University,Yichang 443000,Hubei,China)

机构地区：[1]湖北中医药高等专科学校医基部,湖北荆州434020 [2]陕西中医药大学,陕西咸阳712046 [3]三峡大学第二人民医院神经内科,湖北宜昌443000

出　　处：《中国中西医结合急救杂志》2021年第2期150-153,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：湖北省卫生健康委员会科研项目(WJ2019M065)。

摘　　要：目的分析低分子肝素联合替罗非班治疗急性非Q波心肌梗死(NQMI)患者的应用效果及对患者预后的影响.方法回顾性分析2016年4月至2018年6月三峡大学第二人民医院收治的94例NQMI患者的临床资料,根据急救用药不同分为低分子肝素组(28例)、替罗非班组(30例)和联合用药组(36例).评估患者用药后胸痛症状缓解及心电图缺血改善情况,记录治疗前及治疗12 h、24 h血清心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)变化,并评估患者近期预后.结果3组患者的性别、年龄、体重、发病时间及有吸烟史比例比较差异均无统计学意义(均P>0.05).联合用药组的胸痛症状缓解率和心电图缺血改善率均明显高于低分子肝素组和替罗非班组〔胸痛症状缓解率:97.22%(35/36)比75.00%(21/28)、80.00%(24/30),心电图缺血改善率:91.67%(33/36)比60.71%(17/28)、70.00%(21/30),均P<0.05〕.联合用药组治疗12 h、24 h血清cTnI和CK-MB水平均明显低于同时间点低分子肝素组和替罗非班组〔cTnI(μg/L):12 h为0.35±0.06比0.40±0.07、0.41±0.08,24 h为0.19±0.04比0.28±0.06、0.26±0.06;CK-MB(U/L):12 h为0.49±0.10比0.60±0.15、0.61±0.12,24 h为0.29±0.05比0.35±0.07、0.33±0.06,均P<0.05〕.替罗非班组和联合用药组分别仅有1例和2例出现皮下瘀血,3组均未发现其他明显不良反应.3组治疗后60 d内均未发生心源性猝死事件;联合用药组的主要心脏不良事件(MACE)总发生率明显低于低分子肝素组和替罗非班组〔8.33%(3/36)比28.57%(8/28)、33.33%(10/30),均P<0.05〕.结论低分子肝素联合替罗非班治疗NQMI患者的救治效果和近期预后改善情况均优于单用一种药物,且不会增加用药安全问题.Objective To analyze the application effect of low molecular weight heparin combined with Tirofiban in emergency treatment of patients with acute non-Q-wave myocardial infarction(NQMI)and its influence on their prognosis.Methods The clinical data of 94 NQMI patients admitted to the Second People's Hospital of Three Gorges University from April 2016 to June 2018 were retrospectively analyzed.They were divided into low molecular weight heparin group(28 cases),Tirofiban group(30 cases)and combination of above 2-medication group(36 cases)according to different emergency medications.The remission of chest pain symptoms of patients and the alleviation of ischemia shown in electrocardiogram were evaluated after treatment.The changes of serum myocardiac troponin(cTnI)and creatine kinase isoenzyme(CK-MB)before and 12 hours,24 hours after medications were observed,and the short-term prognosis was evaluated.Results There were no significant differences in gender,age,body weight,time of onset and the proportion of smoking history among the three groups(all P>0.05).The remission of chest pain symptom[97.22%(35/36)vs.75.00%(21/28),80.00%(24/30)],and the improvement rate of electrocardiogram ischemia[91.67%(33/36)vs.60.71%(17/28),70.00%(21/30)]of combination medication group were significantly higher than those in low molecular weight heparin group and the Tirofiban group(all P<0.05).At 12 hours and 24 hours after treatment,the serum cTnI levels(μg/L:0.35±0.06 vs.0.40±0.07,0.41±0.08 at 12 hours,0.19±0.04 vs.0.28±0.06,0.26±0.06 at 24 hours),and the CK-MB levels(U/L:0.49±0.10 vs.0.60±0.15,0.61±0.12 at 12 hours,0.29±0.05 vs.0.35±0.07,0.33±0.06 at 24 hours)in combination medication group were significantly lower than those in low molecular weight heparin group and Tirofiban group(all P<0.05).There were only 1 case and 2 cases with subcutaneous ecchymosis in Tirofiban group and combination medication group,respectively,and there was no other obvious adverse reactions in the three groups.Sudden cardiac death within 60 da

关 键 词：低分子肝素 替罗非班 联合应用 急性非Q波心肌梗死 急救治疗 近期预后 

分 类 号：R54[医药卫生—心血管疾病]