替罗非班联合DAPT在急性心肌梗死行择期PCI患者中的应用效果  

Effect of Tirofiban combined with DAPT in patients with acute myocardial infarction undergoing elective PCI

作　　者：袁基科 朱洋波 沈磊 李山峰 韩永生 YUAN Jike;ZHU Yangbo;SHEN Lei;LI Shanfeng;HAN Yongsheng(Department of Emergency Medicine Center,The First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院急救医学中心,安徽合肥230001

出　　处：《西部医学》2022年第11期1655-1659,共5页Medical Journal of West China

摘　　要：目的探讨替罗非班联合双联抗血小板治疗(DAPT)在急性心肌梗死(AMI)行择期经皮冠状动脉介入治疗(PCI)患者中的应用效果。方法纳入2018年6月~2020年5月中国科学技术大学附属第一医院急诊科收治的72例行择期PCI的AMI患者,随机分为观察组(替罗非班联合DAPT,n=37)和对照组(普通DAPT,n=35),统计比较两组患者的胸痛症状、围手术期出血率、心脏不良事件、冠脉TIMI血流分级、心脏射血分数(LVEF)。结果观察组的无胸痛患者比率(94.6%)高于对照组(77.1%),差异有统计学意义(P<0.05);围手术期观察组的出血率(5.4%)与对照组(5.7%)比较差异无统计学意义(P>0.05);观察组的心脏不良事件比率(10.8%)显著低于对照组(31.4%),差异有统计学意义(P<0.05);支架释放前观察组获得血流TIMI3级人数占比(78.4%)与对照组(60.0%)比较,差异无统计学意义(P>0.05);支架释放后观察组获得血流TIMI3级人数占比(97.3%)与对照组(77.1%)对比,差异有统计学意义(P<0.05);PCI前在各罪犯血管分组中观察组和对照组的LVEF均无明显差异(P>0.05);PCI后在LAD组、LCX组中观察组的LVEF值高于对照组,差异有统计学意义(P<0.05),而在RCA组中两组LVEF无明显差异(P>0.05)。结论替罗非班不增加出血风险,联合DAPT能够恢复AMI患者冠脉血流、降低心脏事件发生率及改善心功能,应用于择期PCI的AMI患者有一定疗效。Objective To investigate the effect of tirofiban combined with dual antiplatelet therapy(DAPT)in patients with acute myocardial infarction(AMI)undergoing elective PCI.Methods A total of 72 AMI patients with elective PCI admitted to The First Affiliated Hospital of USTC from June 2018 to May 2020 were randomly divided into study group with tirofiban combined with DAPT and control group with ordinary DAPT.The differences in chest pain symptoms,perioperative bleeding rate,cardiac adverse events,coronary TIMI blood flow grade and LVEF between the two groups were analyzed.Results The ratio of patients without chest pain was 94.6%in the study group higher than that in the control group(77.1%)(P<0.05).There was no significant difference in perioperative bleeding rate between the study group and the control group(P>0.05).The rate of adverse cardiac events was significantly lower in the study group(10.8%)than in the control group(31.4%)(P<0.05).There was no significant difference between the study group and the control group in the number of people who obtained TIMI3 level of blood flow before stent being released(P>0.05).However,the number of patients in the study group(97.3%)with blood flow TIMI3 after stent being released was higher than that in the control group(77.1%)(P<0.05).Before being acquired PCI treatment,there was no significant difference in LVEF between the study group and the control group in each criminal vessel group(P>0.05).After being acquired PCI treatment,the LVEF of patients with LAD and LCX lesions in the study group were higher than that of the control group(P<0.05),but there was no difference in LVEF of patients with RCA lesions between the study group and the control group(P>0.05).Conclusion Tirofiban does not increase the risk of bleeding.It combined with DAPT can restore coronary blood flow,reduce the incidence of cardiac events and improve cardiac function in AMI patients.Therefore,it has potential benefits for AMI patients undergoing elective PCI.

关 键 词：替罗非班 双联抗血小板治疗 急性心肌梗死 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]