替罗非班联合替格瑞洛与阿司匹林双重抗栓对急诊冠脉介入术老年STEMI患者的疗效和安全性观察  

Efficacy and safety of tirofiban combined with tegrarol and aspirin in the treatment of elderly STEMI patients undergoing emergency coronary intervention

作　　者：郑晓菲 熊波[1] 廖蕾[1] ZHENG Xiao-fei;XIONG Bo;LIAO Lei(Department of Cardiology,Chengdu Third People's Hospital,Chengdu Sichuan 610031,China)

机构地区：[1]成都市第三人民医院心血管内科,四川成都610031

出　　处：《临床和实验医学杂志》2022年第14期1485-1489,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省卫生和计划生育委员会科研项目(编号:18PJ403)。

摘　　要：目的探讨替罗非班联合替格瑞洛与阿司匹林双重抗栓治疗老年ST段抬高型心肌梗死(STEMI)患者的效果以及安全性,为临床诊疗提供依据。方法选取2017年8月至2020年12月在成都市第三人民医院住院经过急诊经皮冠脉介入治疗(PCI)的老年急性STEMI患者127例进行回顾性分析。根据是否采用替罗非班治疗分为两组:对照组患者采用替格瑞洛联合阿司匹林治疗(n=57),观察组在此基础上联合替罗非班治疗(n=70)。住院治疗期间,比较两组治疗效果及患者服药后各时间点血小板聚集率情况,记录治疗前、治疗后血清基质金属蛋白酶-9(MMP-9)、亲环素A(CypA)、肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)和心功能指标[左室射血分数(LVEF)、左室收缩末期容积指数(LVESVI)、左室舒张末期容积指数(LVEDVI)]变化,统计治疗过程中不良事件尤其出血发生情况。结果治疗后,观察组无复流率、慢血流率为1.43%、5.71%,均低于对照组(12.28%、17.54%),而观察组TIMI3比率为92.86%,高于对照组(70.18%),差异均有统计学意义(P<0.05)。观察组患者服药后各时间点血小板聚集率均明显低于对照组,差异有统计学意义(P<0.05),且随着服药时间的延长,血小板聚集率逐渐下降。治疗后,两组患者MMP-9、CypA水平均较治疗前降低,且观察组MMP-9、CypA水平为(33.58±4.21)、(5.15±0.92)ng/mL,明显低于对照组[(37.41±4.79)、(6.24±0.97)ng/mL],差异均有统计学意义(P<0.05)。治疗后,两组患者的CK、CK-MB、cTnI水平均较治疗前升高,但观察组CK、CK-MB、cTnI水平为(318.17±20.78)IU/L、(54.18±5.78)IU/L、(12.17±3.10)μg/L,均低于对照组[(329.79±21.78)IU/L、(61.12±4.88)IU/L、(16.27±2.98)μg/L],差异均有统计学意义(P<0.05)。术后30 d,观察组LVEF为(56.35±4.77)%,高于对照组[(52.41±4.49)%],LVESVI、LVEDVI为(23.17±5.68)、(48.37±5.25)mL/m 2低于对照组[(25.74±5.13)、(48.37±5.25)mL/m 2],差异均有统计�Objective To explore the efficacy and safety of tirofiban combined with tegrarol and aspirin in the treatment of ST segment elevation myocardial infarction(STEMI)in the elderly.Methods A total of 120 cases of elderly acute STEMI hospitalized in Chengdu Third People's Hospital from August 2017 to December 2020 after emergency percutaneous coronary intervention(PCI)were analyzed retrospectively.According to whether tirofiban was used,60 cases were divided into two groups.The patients in the control group were treated with tigril and aspirin,while those in the observation group were treated with tirofiban.After 2 weeks of treatment,the platelet aggregation rate of the two groups was compared at each time point after treatment.The changes of serum matrix metalloproteinases-9(MMP-9)and cyclophilin A(CypA),cardiac troponin I(cTnI),creatine kinase(CK),creatine kinase MB(CK-MB)before and after treatment were recorded and cardiac function indicators[left ventricular ejection fraction(LVEF),left ventricular end-systolic volume index(LVESVI),left ventricular end-diastolic volume index(LVEDVI)],and the occurrence of adverse events during the treatment was counted.Results After treatment,the non recovery flow rate and slow blood flow rate of the observation group were 1.43%and 5.71%,respectively,which were lower than those of the control group(12.28%and 17.54%),while the TIMI rate of the observation group was 92.86%,which was higher than that of the control group(70.18%),the differences were statistically significant(P<0.05).The platelet aggregation rate of the observation group was significantly lower than that of the control group,the difference was statistically significant(P<0.05),and the platelet aggregation rate decreased with the prolongation of the treatment time.After treatment,the levels of MMP-9,CypA in the two groups decreased,and the levels of MMP-9,CypAin the observation group were(33.58±4.21)ng/mL,(5.15±0.92)ng/mL,which were significantly lower than those in the control group[(37.41±4.79)ng/mL,(6.24±0.97)ng

关 键 词：老年 ST段抬高型心肌梗死 阿司匹林 替罗非班 替格瑞洛 疗效 

分 类 号：R542.22[医药卫生—心血管疾病]