替罗非班在老年高危非ST段抬高型急性冠脉综合征患者介入治疗中的作用

摘要

Objective To observe the effect of Tirofiban in the percutaneous coronary intervention (PCI) for elderly pa-tients with hish-risk non-ST-elevation acute coronary syndrome (NSTE-ACS). Methods Three hundred and twenty cases of elderly patients with hish-risk NSTE-ACS receiving PCI in Daping Hospital and the Research Institute of Surgery of the Third Military Medical University from February 2012 to February 2015 were selected and divided into two groups including 162 cases of control group (conventional treatment) and 158 cases of observation group (conven-tional treatment + Tirofiban). The TIMI myocardial perfusion grading before and after PCI of the two groups was com-pared, the clinical efficacy of the two groups was analyzed, the platelet aggregation levels and platelet count of the two groups were measured, the incidence of major adverse cardiovascular event (MACE) was recorded after a follow-up pe-riod of 30 d, and the incidence of bleeding complications was observed. Results The TIMI myocardial perfusion grades after PCI were significantly better than the control group (P< 0.05); the total effective rate of observation group was 93.7%, which was significantly higher than that of control group (87.0%) (P< 0.05); the platelet aggregation rate after PCI in observation group (0.29±0.09) was also significantly lower than that of control group (0.40±0.10) (P<0.05); fol-low-up for 30 d after PCI, the incidence of MACE in observation group (8.9%) was significantly lower than that of con-trol group (14.2%) (P< 0.05); while the incidence of bleeding complications between the two groups had no significant differences (P>0.05). Conclusion For elderly patients with hish-risk NSTE-ACS, Tirofiban can significantly improve TIMI myocardial perfusion levels, reduce platelet aggregation, improve clinical efficacy and short-term clinical progno-sis, without increasing the risk of bleeding, which is worthy of clinical application.%目的：观察替罗非班在老年高危非ST段抬高型急性冠脉综合征(NSTE-ACS)患者介入治疗中的作用。方法选择2012年2月~2015年2月在第三军医大学大坪医院野战外科研究所拟行经皮冠脉介入治疗(PCI)的老年高危NSTE-ACS患者320例,将其分为对照组162例(常规治疗)和观察组158例(常规治疗+替罗非班)。比较两组患者PCI治疗前后TIMI心肌灌注分级情况,分析两组患者的临床治疗效果,检测两组血小板聚集率和血小板计数,随访30 d,记录两组心血管不良事件(MACE)发生率,观察出血并发症的发生率。结果 PCI术后观察组TIMI心肌灌注水平明显优于对照组(P<0.05)；观察组总有效率为93.7%,明显高于对照组(87.0%),差异有统计学意义(P<0.05)；PCI术后观察组血小板聚集率(0.29±0.09)也明显低于对照组(0.40±0.10)(P<0.05)；术后随访30 d,观察组MACE发生率(8.9%)明显低于对照组(14.2%)(P<0.05)；而两组出血并发症发生率比较差异无统计学意义(P>0.05)。结论对于老年高危NSTE-ACS患者,替罗非班能有效地改善患者TIMI心肌灌注水平,降低血小板聚集率,提高临床疗效,改善近期临床预后水平,而不增加出血风险,值得临床运用。