【摘要】 目的探讨冠脉内盐酸替罗非班注射液不同时机给药对急性ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入术(PCI)治疗后临床疗效的影响。方法选择2015年1月-2017年12月在本院心血管内科收治的198例STEMI患者,根据患者就诊顺序随机分为治疗组(n=101)和对照组(n=97),两组患者均予PCI术治疗,治疗组患者在PCI术中通过导丝、球囊扩张后经指引导管冠状动脉内推注负荷剂量盐酸替罗非班注射液,对照组患者在PCI术球囊扩张前,经指引导管冠状动脉内给药,观察患者PCI术后即刻TIMI血流分级达3级例数、术后3hST段回落程度、术后7d左室射血分数(LVEF/%)和E/A值及住院期间主要不良心血管事件(MACE)发生率。结果(1)PCI术后治疗组患者达TIMI-3级血流人数为95例,对照组为82例,2组比较差异具有统计学意义(χ~2=4.73,P=0.029 6),治疗组患者达TIMI-3级血流例数明显多于对照组。(2)PCI术后3h治疗组患者ST段完全回落79例,部分回落14例,未回落8例,回落率为92.1%;对照组患者完全回落64例,部分回落15例,未回落18例,回落率为81.4%,2组间比较差异具有统计学意义(χ~2=4.91,P=0.026)。(3)PCI术后7d,2组患者LVEF比较差异无统计学意义(t=1.45,P=0.148),E/A值比较差异具有统计学意义(t=2.62,P=0.009 4)。(4)治疗组患者PCI术后住院期间共发生7例MACE,发生率为6.93%,对照组患者共发生16例,发生率为16.4%,2组比较差异具有统计学意义(χ~2=5.21,P=0.022),治疗组患者MACE发生率明显低于对照组。结论冠脉内盐酸替罗非班注射液不同时机给药能够影响STEMI患者行PCI术治疗后的临床疗效;在PCI术中通过导丝、球囊扩张后给药能够较好地逆转无复流情况、改善ST段回落程度和左室舒张功能,降低短期内主要不良心血管事件的发生。更多还原

【Abstract】 Objective To investigate the clinical effect of intracoronary administration of Tirofiban at different time points in patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing PCI.Methods A total of 198STEMI patients were admitted to the hospital from January 2015to December 2017were randomly divided into treatment group(n=101)and control group(n=97)).Two groups were treated with PCI therapy.In the treatment group,a load dose of Tirofiban Hydrochloride Injection was injected into the coronary artery through the guide tube and balloon dilation in the PCI operation.The control group was administered in the coronary artery before the balloon dilation of the PCI operation.The cases of regaining TIMI-3blood flow(Thrombolysis In Acute Myocardial Infarction),postoperative 3h ST-segment Resolution,left ventricular ejection fraction(LVEF/%)and E/A value in 7 days,and incidence of major adverse cardiovascular events(MACE)during hospitalization were observed.Results(1)There were 95cases in the treatment group regaining TIMI-3blood flow immediately after PCI,while 82cases in the control group.The difference was statistically significant(χ~2=4.73,P=0.029 6);(2)After 3hours of PCI surgery,there were 79cases in the treatment group with ST-segment complete recovery,14cases with partial recovery,and 8cases without falling down back at all,and the rate of ST-segment resolution was 92.1%.In the control group,there were 64cases with ST-segment complete recovery,15cases with partial recovery,and 18cases without falling down back at all,and the rate of ST-segment resolution was81.4%,where there was significant difference between the two groups(χ~2=4.91,P=0.026);(3)After7dof PCI,there was no significant difference in LVEF between the two groups(t=1.45,P=0.148),while there was statistical significance in the E/A value between the two groups(t=2.62,P=0.009 4);(4)7cases of MACE in the treatment group occurred during hospitalization after PCI,while 16cases in the control group,and the incidence were 6.93%and 16.4%respectively.The difference was statistically significant(χ~2=5.21,P=0.022).Conclusion Intracoronary administration of Tirofiban at different time can affect the clinical efficacy of PCI in STEMI patients.Dilating the blockage or stenosis after intracoronary administration of Tirofiban with PCI can reverse the no-reflow situation and improve the ST segment resolution and left ventricular diastolic function,and reduce the incidence of major adverse cardiovascular events in short term.更多还原