【摘要】 目的探讨替罗非班对介入治疗后ST段回落不良的急性心肌梗死患者的影响。方法选取2015年3月至2017年3月潮州市中心医院经皮冠状动脉介入(percutaneous coronay intervention,PCI)治疗后ST段回落不良急性心肌梗死患者80例,采用随机数字表法分为常规剂量组(n=40)与低剂量组(n=40)。两组均采取PCI治疗,术后1 h静脉注射替罗非班,随后常规剂量组连续静脉注射常规剂量替罗非班,低剂量组静脉注射低剂量替罗非班。比较两组PCI治疗前及后30 d、6个月左心室射血分数(left ventricular ejection fraction,LVEF)、治疗前及治疗后脑钠肽(brain natriuretic peptide,BNP)及C-反应蛋白(C-reactive protein,CRP)血清浓度、PCI治疗后30 d及治疗后6个月的主要不良心血管事件(major adverse cardiovascular events,MACE)(靶血管重建、再次心肌梗死、病死、心源性休克、心力衰竭)发生率及出血事件发生率。结果 (1)PCI治疗后30 d、6个月两组LVEF较治疗前增高,差异有统计学意义(P<0.05);但PCI治疗后不同时间段的LVEF组间比较,差异无统计学意义(P>0.05)。(2)治疗后两组BNP及CRP血清浓度较治疗前降低,差异有统计学意义(P<0.05);但治疗后组间比较,差异无统计学意义(P>0.05)。(3)PCI治疗后30 d低剂量组MACE发生率(12.50%)与常规剂量组(10.00%)比较,差异无统计学意义(P>0.05)。(4)PCI治疗后6个月低剂量组MACE发生率(20.00%)与常规剂量组(17.50%)比较,差异无统计学意义(P>0.05)。(5)低剂量组出血事件发生率(10.00%)低于常规剂量组(27.50%),差异有统计学意义(P<0.05)。结论采取低剂量与常规剂量替罗非班治疗ST段回落不良急性心肌梗死均可有效改善患者LVEF,降低BNP及CRP血清浓度,减少PCI治疗后MACE发生率,且低剂量替罗非班还可有效降低出血事件发生风险,利于保证治疗安全性。更多还原

【Abstract】 Objectives To investigate the effect of tirofiban on patients with acute myocardial infarction and poor ST-segment regression(STR)after percutaneous coronay intervention(PCI)therapy.MethodsEighty patients with acutemyocardial infarction and poor STR after PCI in Chaozhou Central Hospital were selected from March 2015 to March2017. The patients were divided into conventional dose group(n=40)and low dose group(n=40)by randomized digitaltable. PCI was performed in both groups and tirofiban was given intravenously 1 h after PCI. Then,patients in conven-tional dose group received continuous intravenous infusion of tirofiban and patients in low-dose group received low-dose tirofiban. Left ventricular ejection fraction(LVEF),serum concentrations of brain natriuretic peptide(BNP)andC-reactive protein(CRP)before and after PCI,30 days before PCI and 30 days after PCI,incidence of adverse cardio-vascular events(MACE)(target revascularization,re-myocardial infarction,death,cardiogenic shock,heart failure)and incidence of bleeding events in 6 months after PCI were compared between the two groups.Results(1)LVEF ofthe two groups significantly increased at 30 days and 6 months after PCI(P<0.05),but there were no significant differ-ences between LVEF at different time points between the two groups(P>0.05).(2)Serum concentrations of BNP andCRP in the two groups after treatment were lower than those before PCI(P<0.05),but there was no significant differencebetween the two groups after PCI(P>0.05).(3)There was no significant difference in incidence of MACE betweenlow dose group(12.50%)and conventional dose group(10.00%)at 30 days after PCI(P>0.05).(4)There was nosignificant difference in incidence of MACE between low dose group(20.00%)and conventional dose group(17.50%)at 6 months after PCI(P>0.05).(5)Incidence of hemorrhagic events in low-dose group(10.00%)was significantlylower than that in conventional dose group(27.50%)(P<0.05).ConclusionsLow-dose and conventional doses of tirofi-ban for the treatment in patients with acute myocardial infarction with poor STR can effectively improve LVEF,reduceBNP and CRP serum concentrations,reduce MACE after PCI,and low-dose tirofiban can also effectively reduce therisk of bleeding events,which is conductive to the safety of treatment.更多还原