机构地区:[1]平顶山市第二人民医院心血管内科,平顶山467000 [2]河南省人民医院心血管内科,郑州450003
出 处:《中国合理用药探索》2023年第4期107-114,共8页Chinese Journal of Rational Drug Use
基 金:河南省医学科技攻关计划项目(182102310031)。
摘 要:目的:探讨冠状动脉内应用地尔硫[艹卓]联合替罗非班对急性ST段抬高型心肌梗死(STEMI)患者急诊介入疗效的影响。方法:选择某院2019年1月~2020年12月接受治疗的STEMI患者180例作为研究对象,采用随机数字表法分为观察组和对照组,每组90例。观察组于冠脉内应用地尔硫[艹卓]联合替罗非班治疗,对照组单用替罗非班治疗。于急诊经皮冠状动脉介入治疗(PCI)前后对两组患者进行心肌梗死溶栓(TIMI)试验血流分级以及TIMI心肌灌注分级(TMPG)评估;比较两组PCI术后即刻校正的TIMI血流帧数(cTFC)、无复流、ST段完全回落率;于术前和术后7天检测两组患者心肌酶谱水平;比较两组患者院内出血情况及术后6个月内主要心血管不良事件(MACE)发生情况。结果:两组患者PCI术后TIMI血流分级及TMPG分级均较术前升高(P<0.05),且观察组高于对照组(P<0.05)。观察组PCI术后即刻cTFC、无复流率均低于对照组(P<0.05),ST段完全回落率高于对照组(P<0.05)。两组患者PCI术后7天血清LDH、CK和CK-MB水平均较术前降低(P<0.05),且观察组低于对照组(P<0.05)。与对照组相比,观察组患者出血事件发生率无统计学差异[6.67%(6/90)vs 5.56%(5/90),P>0.05]。术后6个月内,观察组MACE发生率低于对照组[5.56%(5/90)vs 17.78%(16/90),P<0.05]。结论:冠脉内应用地尔硫[艹卓]联合替罗非班能安全有效地改善STEMI患者急诊PCI术后心肌灌注水平,降低心肌酶谱水平,改善患者预后。Objective:To investigate the effects of intra-coronary artery application of Diltiazem combined with tirofiban on emergent percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction(STEMI).Methods:A total of 180 patients with STEMI treated during January 2019 to December 2020 were selected and randomly divided into observation group and control group with 90 patients in each group.The observation group was treated with diltiazem combined with tirofiban administered through intra-coronary artery delivery,while the control group was treated with tirofiban alone.Patients were evaluated for thrombolysis in myocardial infarction(TIMI)flow grade and TIMI myocardial perfusion grade(TMPG)before and after emergent percutaneous coronary intervention(PCI)in both groups.Corrected TIMI frame count(cTFC),no reflow phenomenon and rate of complete ST segment resolution were compared immediately after PCI between the two groups.The levels of myocardial enzymes were determined at pre-intervention and 7 days post-intervention for patients in both groups.In-hospital bleeding events and major adverse cardiovascular events(MACE)occurring within 6 months post-intervention were compared between the two groups.Results:TIMI flow grade and TMPG grade after PCI were significantly improved in both groups than pre-intervention(P<0.05),with more obvious improvement in the observation group than in the control group(P<0.05).The cTFC and rate of no reflow phenomenon immediately after PCI in observation group were lower than those in control group(P<0.05).The percent of patients with complete ST segment resolution was higher in the observation group than that of control group(P<0.05).Serum LDH,CK and CK-MB levels in both groups at 7 days after PCI were decreased compared with pre-invention(P<0.05),with lower levels in the observation group than in the control group(P<0.05).There was no significant difference in the incidence of bleeding events in the observation group compared with the control group[6.67%
关 键 词:地尔硫[艹卓] 替罗非班 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 心肌灌注
分 类 号:R541.4[医药卫生—心血管疾病]
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