替罗非班联合肝素在急性心肌梗死急诊介入治疗中应用的疗效及安全性的评价

发布时间：2018-05-20 14:36

本文选题：急性心肌梗死 + 替罗非班　；参考：《大连医科大学》2013年硕士论文

【摘要】：目的评价半量替罗非班与肝素联合应用在急性心肌梗死(Acute myocardialinfarction，AMI)急诊冠脉介入治疗术中的疗效及安全性。方法 1.病例的筛选及分组：本课题采用随机对照的方法，收集2011年5月至2013年1月在辽宁省人民医院住院治疗，且符合纳入标准、排除标准的急性心肌梗死并接受急诊介入治疗的患者。将95例患者随机分为两组，全量组：全量替罗非班＋70iu/kg肝素；半量组：半量替罗非班＋100iu/kg肝素。其中全量组50例，平均年龄53.42±11.41岁，半量组45例，平均年龄49.57±11.68岁。 2.给药方法：两组患者术前均给予负荷量拜阿司匹林300mg、氯吡格雷300mg、阿托伐他汀40mg口服。全量组冠脉造影前静脉给予肝素2500iu，PCI时按总量追加肝素，同时给予负荷量替罗非班10ug/kg，3分钟内推入，继而以0.15ug/(kg·min)持续泵入36小时；半量组冠脉造影前静脉给予肝素2500iu，PCI时追加肝素，同时给予负荷量替罗非班10ug/kg，3分钟内推入，继而以0.075ug/(kg·min)持续泵入36小时。术后36小时两组均开始应用磺达肝癸钠2.5mg/日，同时常规应用拜阿司匹林100mg/日、氯吡格雷75mg/日、阿托伐他汀20mg/日、比索洛尔2.5mg/日及硝酸脂类药物。 3.冠脉造影及冠状介入治疗：由经验丰富的医师对患者行冠脉造影术，同时对梗塞相关动脉行PCI术。 4.观察指标：心肌梗死溶栓试验血流分级(Thrombolysis In MyocardialInfarction，TIMI)，心肌组织灌注水平（TIMI myocardial perfusion grading，，TMPG）方法，校正的TIMI血流帧计数（Corrected TIMI Frame Count， CTFC），2小时内ST段回落情况，术后1周EF值；住院期间的主要MACE事件、TIMI出血及血小板减少并发症。 5.数据处理：数据采用spss13.0软件进行统计学分析，计数资料统计描述采用率或构成比表示，统计学分析采用X2检验或Fisher确切概率法；计量资料统计描述采用均数±标准差表示，统计分析采用两个独立样本的t检验，以P0.05为有统计学意义。结果 1.两组患者在性别、年龄、高血压、糖尿病、高血脂、抽烟、饮酒、BMI等基础资料均无统计学差异。 2.两组患者冠脉造影结果：术后TIMI3级比较，差异无统计学意义（86.0%VS82.2%， P=0.614）；术后TMP3级比较，差异无统计学意义（74.0%VS71.1%，P=0.753）；两组患者PCI术中CTFC计数比较，差异无统计学意义（29.65±4.53VS30.80±3.42，P=0.674）； 3.两组患者临床资料比较：术后两小时ST段回落≥50%比率无统计学差异（90.0%VS88.9%，P=0.860）；全量组与半量组患者术后1周的EF值无统计学差异（0.51±0.06VS0.49±0.06，P=0.583）。 4.住院期间主要心血管不良事件：全量组发生死亡1例，死于心源性休克，半量组无死亡；靶血管重建全量组0例，半量组1例，两组之间无显著差异。 5.住院期间出血及血小板减少情况：全量组发生牙龈出血4例，穿刺部位血肿3例，消化道出血1例，经积极止血治疗后未出现严重并发症，半量组鼻粘膜出血2例，皮肤黏膜1例，穿刺部位出血1例，全量组出血率高于半量组差异有统计学意义（p0.05）；两组患者均未发生血小板减少。 6.两组患者的住院费用(35988yuan±6580.93VS33629±4174.04yuan，P=0.042)及住院天数（8.54±2.59天VS7.84±2.81天， P=0.544）。结论 1.半量组与全量组在改善术后TIMI血流、术后TMP血流、CTFC方面无显著性差异。 2.半量组与全量组住院期间主要MACE事件的发生率及血小板减少的发生率无明显差异。 3.与全量组相比，半量组出血并发症少且住院费用低。
[Abstract]:Objective to evaluate the efficacy and safety of the combined use of semi - tirofiban and heparin in the emergency coronary intervention for acute myocardial infarction (Acute myocardialinfarction, AMI).
Method
The screening and grouping of 1. cases: a randomized controlled method was used to collect hospitalized treatment in Liaoning people's Hospital from May 2011 to January 2013, and to meet the standard, exclude the standard acute myocardial infarction and receive emergency intervention treatment. 95 patients were randomly divided into two groups, full measure: tirofiban + 70iu/kg Heparin, half dose group: half dose tirofiban + 100iu/kg heparin, total volume 50 cases, mean age 53.42 + 11.41 years, half volume group 45 cases, average age 49.57 + 11.68 years old.
2. the method of administration: the two groups were given a load of aspirin 300mg, clopidogrel 300mg, atorvastatin 40mg orally. The whole group was given heparin 2500iu before the total coronary angiography, PCI was added to the total heparin at the time of PCI, and the load of tironon class 10ug/kg was given in 3 minutes, and then continuously pumped with 0.15ug/ (kg min) for 36 hours. In the half volume group, heparin 2500iu, PCI heparin was added to the anterior vein of coronary angiography, and the load was given for Luo Fei class 10ug/kg, 3 minutes was pushed into the group, and then 0.075ug/ (kg. Min) was pumped continuously for 36 hours. 36 hours after the operation, two groups began to apply sulfononura 2.5mg/ day, routine application of aspirin 100mg/ day, clopidogrel 75mg/ day. Atorvastatin 20mg/ days, bisoprolol 2.5mg/ days and nitrates.
3. coronary angiography and coronary intervention: experienced doctors performed coronary angiography and PCI for infarct related artery.
4. observation index: Thrombolysis In MyocardialInfarction (TIMI), myocardial perfusion level (TIMI myocardial perfusion grading, TMPG), corrected TIMI blood flow frame count (Corrected TIMI), 2 hours decline, 1 weeks postoperatively; ACE events, TIMI bleeding and thrombocytopenia complications.
5. data processing: the data are statistically analyzed by SPSS13.0 software, the statistical description of the adoption rate or the ratio of composition is expressed, the statistical analysis uses X2 test or the exact probability of Fisher; the statistical description of the measurement data is represented by the mean mean deviation of the mean number, and the statistical analysis uses the t test of the independent samples, with the P0.05 as the statistics. Significance.
Result
1. there was no statistically significant difference in gender, age, hypertension, diabetes, hyperlipidemia, smoking, drinking, BMI and so on between the two groups.
2. the results of coronary angiography in the 2. two groups: the difference was not statistically significant (86.0%VS82.2%, P=0.614) after the operation (86.0%VS82.2%, P=0.614), and the difference was not statistically significant (74.0%VS71.1%, P=0.753) after the operation (74.0%VS71.1%, P=0.753). The difference of CTFC count in the two groups was not statistically significant (29.65 + 4.53VS30.80 + 3.42, P=0.674).
3. the clinical data of the two groups were compared: there was no statistical difference (90.0%VS88.9%, P=0.860) at two hours after two hours after the operation (90.0%VS88.9%, P=0.860), and there was no statistical difference (0.51 + 0.06VS0.49 + 0.06, P=0.583) at 1 weeks after operation in the whole group and the half volume group.
4. the main cardiovascular adverse events during the hospitalization: 1 cases of death in the whole group, death from cardiogenic shock and no death in the half volume group; 0 cases of total target vessel reconstruction and 1 cases in the half volume group. There was no significant difference between the two groups.
5. bleeding and thrombocytopenia during hospitalization: 4 cases of gingival bleeding in the whole group, 3 cases of hematoma in puncture site, 1 cases of hemorrhage in digestive tract, no serious complications after active hemostasis, 2 cases of nasal mucous bleeding in half volume group, 1 cases of skin mucosa and 1 cases of puncture site bleeding, and the difference of total bleeding rate was higher than that of half volume group (P 0.05); there were no thrombocytopenia in the two groups.
6. the hospitalization expenses of the two groups of patients (35988yuan + 6580.93VS33629 + 4174.04yuan, P=0.042) and length of stay (8.54 + 2.59 days VS7.84 + 2.81 days, P=0.544).
conclusion
1. half volume group and total volume group had no significant difference in improving TIMI blood flow, postoperative TMP blood flow and CTFC.
2. there was no significant difference in the incidence of major MACE events and the incidence of thrombocytopenia in the half volume group and the full volume group during hospitalization.
3. compared with the full dose group, the half volume group had less bleeding complications and lower hospitalization expenses.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R542.22

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