PCI术联合替罗非班对STEMI患者心室跨壁复极离散度的影响及其预后的高危因素分析  

Study on combination of PCI and triofiban in treatment of STEMI patients and the prognostic risk factors

作　　者：陈琳琳 周娟 周瑾 CHEN Linlin;ZHOU Juan;ZHOU Jin(ECG Room of Huai'an Second People's Hospital,Huai'an Jiangsu 223002,China;Color Ultrasound Room of Huai'an Second People's Hospital,Huai'an Jiangsu 223002,China)

机构地区：[1]淮安市第二人民医院心电图室,江苏淮安223002 [2]淮安市第二人民医院彩超室,江苏淮安223002

出　　处：《转化医学杂志》2022年第6期369-373,共5页Translational Medicine Journal

摘　　要：目的 探讨PCI术联合替罗非班对STEMI患者心室跨壁复极离散度的影响,并分析其预后的高危因素。方法 选取2019年7月-2022年7月于淮安市第二人民医院确诊为ST段抬高型心肌梗死并实施PCI术的患者116例。按照随机数表法将116例患者分为对照组(n=58)和实验组(n=58)。对照组与实验组均采用经皮冠状动脉介入治疗(PCI),术中实验组冠脉内予以替罗非班,对照组不予以替罗非班。1个月后,比较观察2组患者不良事件发生率(不稳定心绞痛、恶性心律失常、心肌梗死再发生、心力衰竭、死亡)、生活质量量表(SF-36)评分及T波峰-末间期(Tp-Te)、Tp-Te离散度,并使用多因素Logistic回归分析其预后高危因素。结果 对照组的不良事件发生率高于实验组(P<0.05)。治疗后,实验组SF-36各项评分均高于对照组,Tp-Te、Tp-Te离散度较实验组更低(P<0.05)。多因素Logistic回归分析结果显示良好组的年龄≥65岁、心功能分级≥Ⅲ级、合并高血压、糖尿病、高脂血症、有冠心病家族史、有吸烟史、病变部位为前壁梗死型、冠脉病变≥2支以及未联合替罗非班为PCI手术治疗STEMI患者预后不良的独立高危因素。结论 PCI术联合替罗非班能有效降低STEMI患者术后不良事件发生率,改善其生活质量和Tp-Te、Tp-Te离散度,年龄≥65岁、心功能分级≥Ⅲ级、合并高血压、糖尿病、高脂血症、有冠心病家族史、有吸烟史、病变部位为前壁梗死型及冠脉病变≥2支均为预后的独立高危因素。Objective To study the clinical effect of percutaneous coronary intervention(PCI) combined with tirofiban on transmural dispersion of repolarization in patients with ST-segment elevation myocardial infarction(STEMI),and explore the high-risk factors affecting the prognosis. Methods One hundred and sixteen patients with STEMI underwent PCI in our hospital from July 2019 to July 2022 were enrolled, and devided into two groups by random number table methods, with 58 cases in each group. Before PCI, all patients were administered a loading dose of 300mg aspirin and 180mg ticagrelor. Coronary angiography procedures were performed via radial or femoral artery. PCI combined with thrombus aspiration treatment were performed. Perioperative anticoagulation was achieved with intravenous heparin. Experimental group received intracoronary injection of 10 μg · kg~(-1) tirofiban, while control group received no tirofiban injection. After surgery, all patients were administered with aspirin(100mg once a day) and clopidogrel(75mg once a day). After 1 month of treatment, comparison was conducted on adverse events(unstable angina pectoris, malignant arrhythmia, recurrence of myocardial infarction, heart failure, and death), MOS-36-item short-from health survey(SF-36) score, T wave peak–to–end interval(Tp-Te), and Tp-Te dispersion. Thereafter, risk factors affecting the prognosis in STEMI patients were screened using multivariate Logistic regression analysis model. Results The overall adverse reaction rate of the control group was higher than that of the experimental group(P<0.05). After treatment, experimental group scored higher on SF-36 than control group(P<0.05), and the Tp-Te interval and Tp-Te dispersion were notably decreased in the control group compared with the experimental group(P<0.05). Multivariate logistic regression analysis showed that age ≥ 65 years, cardiac function grade ≥ III, hypertension, diabetes, hyperlipidemia, family history of coronary heart disease, smoking history, lesion site of anterior wall

关 键 词：ST段抬高型心肌梗死 经皮冠状动脉介入治疗 替罗非班 跨壁复极离散度 危险因素 

分 类 号：R542.2[医药卫生—心血管疾病]