替罗非班对急性ST段抬高型心肌梗死介入治疗的临床研究

发布时间：2018-02-20 18:08

本文关键词： 替罗非班急性ST段抬高型心肌梗死冠脉介入治疗血流动力学　出处：《中国临床药理学杂志》2016年13期 　论文类型：期刊论文

【摘要】：目的研究冠状动脉内注射替罗非班在急性ST段抬高型心肌梗死(STEMI)冠脉介入手术治疗(PCI)中对血流动力学的影响。方法选取2011年11月至2012年11月在本院进行PCI术治疗的506例急性ST段抬高型心肌梗死例患者,用随机数字法分为试验组和对照组各253例。对照组于术中经动脉鞘管注射普通肝素5000 U,术后再皮下注射低分子肝素5000 U,连续5 d;试验组于PCI术前,注射替罗非班5μg·kg~(-1),3 min内注射完毕,随后以0.15μg·kg~(-1)·min~(-1)持续泵入36 h。观察治疗前后2组的血流情况、心脏功能指标以及再灌注指标变化情况。结果治疗前,2组患者经溶栓治疗后血流分级(TIMI)比较差异无统计学意义(P0.05)。治疗后与治疗前比较,2组患者的TIMI均明显改善(P0.05),但试验组明显优于对照组(P0.05)。治疗前,2组患者射血分数(LEVF)分别为(43.11±3.25)%,(42.69±3.22)%、左心室舒张末期内径(LVEDD)分别为(41.05±3.22)mm,(41.09±3.31)mm、左心室收缩末期内径(LVESD)分别为(31.66±4.65),(31.05±4.59)mm,2组比较差异无统计学意义(P0.05);治疗后与治疗前比较,2组的各项心脏功能指标均明显改善,但试验组的LEVF值为(58.14±6.85)%明显高于对照组(46.12±4.15)%,而LVEDD为(43.11±3.12)mm、LVESD为(34.01±5.17)mm明显低于对照组(49.79±4.52)mm,(39.88±5.13)mm(P0.05)。患者动脉血流量分级在90 min ST段回落50%的CK-MB峰值以及CK-MB峰值时间等各项指标,试验组均明显优于对照组(P0.05)。结论 STEMI在PCI中,冠状动脉内注射替罗非班可有效改善患者血流动力学,并使心功能得到较好地恢复。
[Abstract]:Objective to study the effect of intracoronary injection of tirofiban on hemodynamics in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing coronary intervention. Methods from November 2011 to November 2012, PCI was performed in our hospital. A total of 506 patients with acute ST-segment elevation myocardial infarction, The patients in the control group were divided into two groups (n = 253). The control group was treated with conventional heparin 5000U intraoperatively and subcutaneously injected low-molecular-weight heparin (LMWH 5000U) after operation for 5 days, and the experimental group was treated before PCI for 5 days. Tirofiban (5 渭 g 路kg ~ (-1)) was injected within 3 min, then pumped continuously into 36 h with 0.15 渭 g 路kg ~ (-1) 路min ~ (-1) 路min ~ (-1). The blood flow of the two groups was observed before and after treatment. Results before and after thrombolytic therapy, there was no significant difference in blood flow grading and tii between the two groups. After treatment, the TIMI of group 2 was significantly improved compared with that of before treatment, and there was no significant difference between the two groups before and after treatment, and there was no significant difference between the two groups before and after treatment, and there was no significant difference between the two groups in blood flow grading after thrombolytic therapy (P 0.05). The mean ejection fraction (LEVF) of the two groups was 43.11 卤3.25 卤42.69 卤3.22, and the LVEDDD of left ventricular end-diastolic diameter was 41.05 卤3.22 卤3.31 卤41.09 卤3.31 mm and 31.66 卤4.65 卤4.59 mm, respectively, and there was no significant difference between the two groups. Compared with before treatment, the cardiac function indexes of the two groups were significantly improved. However, the LEVF value of the trial group was 58.14 卤6.85%, significantly higher than that of the control group (46.12 卤4.15), while the LVEDD of the control group was 43.11 卤3.12 卤3.12 卤5.17 mm, which was significantly lower than that of the control group (49.79 卤4.52 卤5.13 mm, P 0.05). The peak value of CK-MB and the peak time of CK-MB in 90 min St segment were significantly lower than those in the control group. Conclusion Intra-coronary injection of tirofiban in PCI can improve hemodynamics and improve cardiac function in patients with PCI.
【作者单位】：唐山工人医院心内一科;
【基金】：河北省医学科学研究课题基金资助项目(ZL20140252)
【分类号】：R542.22

【参考文献】