不同剂量替罗非班对急性ST...者心肌再灌注及心功能的影响_宋海娥.pdf

-45-中国医学创新第 20 卷 第 5 期（总第 611 期）2023 年 2月临床研究 LinchuangyanjiuMedical Innovation of China Vol.20,No.5 February,2023湖北省监利市中医医院湖北监利433300通信作者：宋海娥不同剂量替罗非班对急性ST段抬高型心肌梗死PCI患者心肌再灌注及心功能的影响宋海娥【摘要】目的：观察不同剂量替罗非班对急性 ST 段抬高型心肌梗死（STEMI）急诊经皮冠状动脉介入（PCI）患者心肌再灌注及心功能的影响。方法：选取 2019 年 3 月-2020 年 3 月 120 例于监利市中医医院就诊的急性 STEMI 患者，按随机数字表法分为 A 组、B 组与 C 组，各 40 例。三组均采取 PCI 治疗，A 组给予常规用药，B 组在 A 组基础上给予替罗非班标准剂量（10 g/kg），C 组在 A 组基础上给予替罗非班半剂量（5 g/kg）。比较三组血清肌酸激酶同工酶（CK-MB）峰值及峰值出现时间、心肌梗死溶栓试验（TIMI）3 级血流与 ST 段回落 50%的占比、梗死相关血管无复流发生率、术后 1 周及术后 4 周的左室射血分数（LVEF）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD），住院期间出血并发症发生率与 1 年随访期间主要不良心血管事件（MACE）发生率。结果：B 组与 C 组的 CK-MB峰值均低于 A 组，CK-MB 峰值出现时间均早于 A 组，B 组与 C 组 ST 段回落 50%占比均高于 A 组，梗死相关血管无复流发生率均低于 A 组（P0.05）。B 组与 C 组术后 1 周与术后 4 周的 LVEF 均高于 A 组，LVEDD 与 LVESD 均低于 A 组（P0.05）。A 组随访期间 MACE 发生率显著高于 B 组与 C 组（P0.05）。B 组出血并发症发生率高于 A 组与 C 组（P0.05）。结论：替罗非班可改善急性 STEMI 患者 PCI 后的远端栓塞和微循环，使心肌再灌注及心功能获得改善，并减少 MACE 发生，且半剂量的出血并发症发生率低于标准剂量。【关键词】急性 ST 段抬高型心肌梗死经皮冠状动脉介入替罗非班心肌再灌注Effects of Different Doses of Tirofiban on Myocardial Reperfusion and Cardiac Function in Patients with Acute ST-segment Elevation Myocardial Infarction/SONG Haie./Medical Innovation of China,2023,20(05):045-049AbstractObjective:To observe the effects of different doses of Tirofiban on myocardial reperfusion and cardiac function in patients with acute ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Method:A total of 120 patients with acute STEMI in Jianli Hospital of Traditional Chinese Medicine from March 2019 to March 2020 were randomly divided into group A,group B and group C,with 40 cases in each group.All three groups were treated with PCI,group A received conventional medication,group B received standard dose(10 g/kg)of Tirofiban based on group A,group C received half dose(5 g/kg)of Tirofiban based on group A.The peak and peak appearance time of creatine phosphate enzyme isozyme(CK-MB),the proportion of thrombolysis in myocardial infarction(TIMI)grade 3 blood flow and ST segment fall 50%,the incidence of no reflow in infarct-related vessels,left ventricular ejection fraction(LVEF),left ventricular end diastolic endocele(LVEDD)and left ventricular end-systolic diameter(LVESD)at 1 week postoperatively and 4 weeks postoperatively,the incidence of bleeding complications during hospitalization and the incidence of major adverse cardiac events(MACE)during 1-year follow-up were compared among three groups.Result:The peak values of CK-MB in group B and group C were lower than that in group A,the time of peak value of CK-MB in group B and group C were earlier than that in group A,the proportions of ST-segment regression 50%in group B and group C were higher than that in group A,and the incidences of no reflow in infarct-related vessels were lower than that in group A(P0.05).LVEF,LVEDD and LVESD in group B and C were higher than those in group A at 1 week and 4 weeks after surgery(P0.05).During the follow-up period,the incidence of MACE in group A was significantly higher than those in group B and group C(P0.05).The incidence of bleeding complications in group B was higher than those in group A and group C(P0.05).Conclusion:Tirofiban can improve distal embolization and microcirculation in patients with acute STEMI,improve myocardial reperfusion and cardiac function,and reduce MACE events,and the half-dose bleeding complication rate is lower than the standard dose.Key wordsAcute ST-segment elevation myocardial infarctionPercutaneous coronary interventionTirofibanMyocardial reperfusionFirst-authors address:Jianli Hospital of Traditional Chinese Medicine,Hubei Province,Jianli 433300,Chinadoi：10.3969/j.issn.1674-4985.2023.05.011-47-中国医学创新第 20 卷 第 5 期（总第 611 期）2023 年 2月临床研究 LinchuangyanjiuMedical Innovation of China Vol.20,No.5 February,2023抑制法测定。1.3.2心肌再灌注指标比较三组 TIMI 3 级血流与ST 段回落 50%的占比、梗死相关血管无复流发生率。1.3.3心功能指标分别于术后 1 周及术后 4 周采用飞利浦 CX50 型心脏超声多普勒（徐州市恒大电子有限公司）测定三组患者的左室射血分数（left ventricular ejection fraction，LVEF）、左 心 室 舒 张末期内径（LVEDD）、左心室收缩末期内径（left ventricular end-systolic diameter，LVESD）。1.3.4出血并发症与主要不良心血管事件（major adverse cardiovascular events，MACE）记录三组住院期间出血并发症与 MACE 发生情况，比较出血并发症发生率。出院后通过电话结合门诊复查的形式对三组患者进行 1 年随访，记录随访期间 MACE，包括再梗死、靶血管重建、频发心绞痛，比较三组MACE 发生率。1.4统计学处理采用 SPSS 24.0 处理数据，计量资料采用均数 标准差（x-s）表示，多组间比较采取单因素的方差分析，两两比较采取 LSD-t 检验；计数资料用率（%）表示，比较行 2检验，以P0.05），具有可比性，见表 1。表1三组一般资料比较组别男/女（例）年龄 岁，（x-s）体重指数kg/m2，（x-s）吸烟史 例（%）发病时间h，（x-s）术前 CK-MBU/L，（x-s）A 组（n=40）23/1761.447.5122.033.3119（47.50）2.500.7442.846.47B 组（n=40）21/1961.968.1221.622.9921（52.50）2.820.8144.305.99C 组（n=40）22/1862.227.9721.602.8818（45.00）2.660.7943.096.222/F 值0.2020.1020.2100.4671.6810.628P 值0.9040.9030.8110.7920.1910.535表1（续）组别梗死相关血管 例（%）合并症 例（%）右冠状动脉回旋支前降支糖尿病高血压高胆固醇血症A 组（n=40）10（25.00）9（22.50）21（52.50）13（32.50）25（62.50）17（42.50）B 组（n=40）11（27.50）7（17.50）22（55.00）11（27.50）27（67.50）19（47.50）C 组（n=40）9（22.50）8（20.00）23（57.50）10（25.00）25（62.50）18（45.00）2/F 值0.4870.5750.2900.202P 值0.0970.7500.8650.9042.2三组 CK-MB 峰值及其出现时间比较B 组的 CK-MB 峰 值 为（191.6581.04）U/L，C 组 为（200.6553.26）