PCI术前应用替罗非班对急性心肌梗死患者相关指标的影响

发布时间：2018-05-03 20:53

本文选题：替罗非班 + 急性心肌梗死　；参考：《中国药房》2017年20期

【摘要】：目的:观察经皮冠状动脉介入治疗(PCI)术前应用替罗非班对急性心肌梗死患者相关指标的影响。方法:采用回顾性分析方法,选取2015年1月-2016年6月我院收治的急性心肌梗死患者128例,根据患者PCI术前是否应用替罗非班分为观察组(76例)和对照组(52例)。对照组患者PCI术前给予阿司匹林肠溶片300 mg,po+硫酸氢氯吡格雷片600 mg,po,术中给予肝素钠注射液100 U/kg,iv。观察组患者在对照组基础上于术前给予盐酸替罗非班氯化钠注射液0.2μg/(kg·min),iv。观察两组患者术后ST段回落情况、胸痛改善情况,术前心肌酸激酶同工酶(CK-MB)水平和术后CK-MB峰值、达峰时间和持续时间,术后心肌梗死溶栓治疗(TIMI)血流分级,术前术后血管性假血友病因子(v WF)、血浆内皮素1(ET-1)和血清一氧化氮(NO)水平,并记录不良反应发生情况。结果:PCI术后,观察组患者ST段回落率(89.47%)明显高于对照组(67.31%),胸痛总缓解率(89.47%)明显高于对照组(75.00%),TIMI血流分级2~3级的患者明显多于对照组,差异均有统计学意义(P0.05)。PCI术前,两组患者CK-MB、v WF、ET-1和NO水平比较,差异均无统计学意义(P0.05);PCI术后,观察组患者CK-MB峰值、达峰时间和持续时间均明显低于或短于对照组;两组患者v WF和ET-1水平均明显降低,NO水平明显升高,且观察组患者v WF、ET-1和NO水平的改善程度明显优于对照组,差异均有统计学意义(P0.05)。观察组患者轻度出血发生率明显低于对照组,中度出血发生率明显高于对照组,差异均有统计学意义(P0.05);但两组患者死亡率比较,差异均无统计学意义(P0.05)。结论:PCI术前应用替罗非班可缓解患者临床症状,改善心功能,保护血管内皮,恢复冠状动脉血流灌注,但应注意其出血风险。
[Abstract]:Aim: to observe the effect of tirofiban on the indexes of patients with acute myocardial infarction (AMI) before percutaneous coronary intervention (PCI). Methods: by retrospective analysis, 128 patients with acute myocardial infarction admitted in our hospital from January 2015 to June 2016 were divided into observation group (n = 76) and control group (n = 52) according to whether tirofiban was used before PCI. Patients in control group were treated with aspirin enteric-coated tablets (300mg / g) po hydroclopidogrel sulfate (600mg / kg) before operation and heparin sodium injection (100U / kg / kg) intraoperatively. The patients in the observation group were given tirofiban hydrochloride sodium chloride injection 0. 2 渭 g/(kg / min before operation on the basis of the control group. The postoperative St segment depression, chest pain improvement, cardiac acid-kinase isoenzyme CK-MBs, peak CK-MB, peak time and duration, blood flow grade of thrombolytic therapy after myocardial infarction were observed in both groups. Before and after operation, the levels of von Willebrand factor v WFI, plasma endothelin 1 (et 1) and serum nitric oxide (no) were recorded, and the adverse reactions were recorded. Results the St segment fall rate (89.47%) in the observation group was significantly higher than that in the control group (67.31%) and the total relief rate of chest pain (89.47 7) in the observation group was significantly higher than that in the control group (75.00%) and the TIMI blood flow grade (2 掳3) was significantly higher in the observation group than in the control group. The difference was statistically significant before PCI. There was no significant difference in the levels of CK-MBV WFFT-1 and no between the two groups after PCI. The peak value, peak time and duration of CK-MB in the observation group were significantly lower than those in the control group. The levels of vWF and ET-1 in the two groups were significantly lower than those in the control group, and the levels of vWF ET-1 and no in the observation group were significantly higher than those in the control group (P 0.05). The incidence of mild hemorrhage in the observation group was significantly lower than that in the control group, and the incidence of moderate hemorrhage in the observation group was significantly higher than that in the control group, and the difference was statistically significant (P 0.05), but there was no significant difference in the mortality between the two groups (P 0.05). Conclusion tirofiban before PCI can relieve clinical symptoms, improve cardiac function, protect vascular endothelium and restore coronary blood flow perfusion, but the risk of bleeding should be paid attention to.
【作者单位】：齐齐哈尔医学院附属第二医院心血管内科;齐齐哈尔医学院附属第二医院神经内科;
【分类号】：R542.22

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