早期使用GPⅡb/Ⅲa受体拮抗剂对STEMI介入治疗的再灌注心律失常的影响  

Clinical research on the early administration of GPⅡb/Ⅲa receptor antagonist for reperfusion arrhythmia in STEMI patients with interventional treatment

作　　者：周勇[1] 徐飞[1] 谢倩倩 魏征[1] 孙彤[1] ZHOU Yong;XU Fei;XIE Qian-qian;WEI Zheng;SUN Tong(Department of Cardiology,Suzhou Hospital of Anhui Medical llniversity,Suzhou Anhui 234000,China)

机构地区：[1]安徽医科大学附属宿州医院心血管内科,安徽宿州234000

出　　处：《蚌埠医学院学报》2022年第1期86-89,共4页Journal of Bengbu Medical College

摘　　要：目的:通过对急性ST段抬高型心肌梗死(STEMI)病人早期使用GPⅡb/Ⅲa受体拮抗剂,观察急诊经皮冠状动脉介入治疗(PCI)时对再灌注心律失常的影响。方法:选择急性ST段抬高心肌梗死行急诊PCI病人90例,根据GPⅡb/Ⅲa受体拮抗剂给药时机不同,将病人分为观察组和对照组,各45例。观察组入院后立即通过静脉给予负荷量替罗非班注射液,对照组在术中由导管经冠脉途径给予负荷量替罗非班注射液。比较2组PCI术前及术后TIMI血流、术后90 min ST段回落百分比及再灌注心律失常的发生。结果:观察组替罗非班至球囊扩张时间为(55.70±16.81)min,明显少于对照组的(3.70±0.72)min(t=22.73,P<0.01)。观察组使用替罗非班总量为(11.82±2.68)mg,对照组为(10.75±2.74)mg,2组差异无统计学意义(t=1.87,P>0.05)。2组病人冠状动脉病变支数和靶血管位置差异均无统计学意义(P>0.05)。PCI术前冠脉造影显示,观察组梗死相关血管TIMI血流较对照组明显改善(P<0.01),对照组TIMI血流2、3级病人共6例,观察组TIMI血流2、3级病人15例,差异有统计学意义(P<0.05);PCI术后,观察组梗死相关血管TIMI血流3级病人43例,对照组35例,差异有统计学意义(P<0.05)。与对照组相比,观察组90 min内ST段回落明显,差异有统计学意义(P<0.05)。观察组总的RA发生率明显低于对照组(P<0.01),其中观察组严重心律失常发生率低于对照组(P<0.05)。结论:STEMI病人早期使用GPⅡb/Ⅲa受体拮抗能显著改善PCI术中的再灌注心律失常,明显改善心肌再灌注。Objective:To study the efficacy of the early administration of GPⅡb/Ⅲa receptor antagonist in the tratment of reperfusion arrhythmia(RA)in acute ST-segment elevation myocardial infarction(STEMI)patients treated with emergency percutaneous coronary intervention(PCI).Methods:Ninety STEMI patients treated with emergency PCI were randomly divided into the observation group(45 cases treated with tirofiban injection intravenously immediately after admission)and control group(45 cases treated with tirofiban injection during PCI).The TIMI blood flow before and after PCI,percentage of ST segment drop after 90 min of PCI and occurrence of RA were compared between two groups.Results:The time from tirofiban to balloon dilation in observation group[(55.70±16.81)min]was significantly shorter than that in control group[(3.70±0.72)min](t=22.73,P<0.01).The total amount of tirofiban use in the observation group and control group was[(11.82±2.68)mg]and[(10.75±2.74)mg],respectively,and the difference of which was not statistically significant(t=1.87,P>0.05).There was no statistical significance in the number of coronary artery lesions and target vessel position between two groups(P>0.05).The results of preoperative coronary angiography showed that the TIMI blood flow of infarct related vessels in the observation group was significantly improved compared with that in the control group(P<0.01).There were 6 cases with level 2 and 3 TIMI blood flow in the control group and 15 cases with level 2 and 3 TIMI blood flow in the observation group,and the difference of which was statistically significant(P<0.05).After PCI,43 cases with level 3 TIMI in the observation group and 35 cases with level 3 TIMI in the control group were found,and the difference of which was statistically significant(P<0.05).Compared with the control group,the ST segment in the observation group decreased significantly within 90 min,and the difference of which between two groups was statistically significant(P<0.05).The total incidence rate of RA in the observa

关 键 词：心肌梗死 GPⅡb/Ⅲa受体拮抗剂 经皮冠状动脉介入治疗 再灌注心律失常 

分 类 号：R542[医药卫生—心血管疾病]