NSTE-ACS患者围手术期不同剂量替罗非班联合氯吡格雷强化治疗的应用

摘要

目的 比较非ST段抬高型急性冠脉综合征(NSTE-ACS)患者围手术期应用不同剂量替罗非班联合氯吡格雷强化治疗的临床效果.方法 选取揭阳市人民医院于2013年10月~2016年4月收治拟定实施冠状动脉介入治疗(PCI)的100例NSTE-ACS患者作为研究对象,男性54例,女性46例.随机分为A组和B组,各50例.两组患者均行PCI,且术前与术后进行抗血小板治疗.A组手术中冠状动脉内推注10.0 μg/kg的替罗非班,并以0.15 μg/(kg·min)的速度静脉持续泵注12~48 h.B组手术中冠状动脉内推注5.0 μg/kg的替罗非班,3 min内完成,持续以0.075 μg/(kg·min)速度静脉泵注,持续12~48 h.介入手术治疗前后评估心肌梗死溶栓试验(TIMI)血流分级.术前与术后1个月进行心脏彩色超声检查,包括左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD).统计术后1个月内不良心血管事件.结果 与治疗前比较,A组与B组患者治疗后TIMI血流0级和1级比例减少,TIMI血流3级比例明显增加,差异有统计学意义(P均<0.05).治疗后A组较B组患者TIMI血流3级比例增加(76.0% vs. 52.0%),差异有统计学意义(P<0.05).A组与B组患者治疗后较治疗前LVEF、LVESD、LVEDD指标均改善,差异有统计学意义(P均<0.05).治疗后A组较B组患者LVEF、LVESD、LVEDD等指标改善更明显,差异有统计学意义(P均<0.05).A组不良心血管事件发生率为4.0%,B组为16.0%,A组低于B组,差异具有统计学意义(P<0.05).结论 NSTE-ACS围手术期全剂量替罗非班联合氯吡格雷强化治疗较半剂量替罗非班联合氯吡格雷更具优越性,改善患者心脏功能与血流状况更明显,不良心血管事件发生率更低,安全性高,值得临床中应用.%Objective To compare the clinical efficacy of tirofiban combining clopidogrel in different doses in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) during perioperative period. Methods NSTE-ACS patients (n=100, male 54 and female 46) prepared to undergo percutaneous coronary intervention (PCI) were chosen from the People's Hospital of Jieyang City from Oct. 2013 to Apr. 2016, and randomly divided into group A and group B (each n=50). All patients in 2 groups were given anti-platelet therapy (aspirin and clopidogrel) before and after PCI. Group A was given tirofiban (10.0 μg/kg) by intracoronary injection during the operation, and then by continuous intravenous pumping [0.15 μg/(kg·min)] for 12 h to 48 h. Group B was given tirofiban (5.0 μg/kg) by intracoronary injection within 3 min during the operation, and then by continuous intravenous pumping [0.075 μg/(kg·min)] for 12 h to 48 h. The flow grades of thrombolysis in myocardial infarction (TIMI) were reviewed before and after PCI. The patients were given color ultrasound examination for detecting left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic inner diameter (LVEDD) before and 1 m after PCI. The adverse cardiovascular events were counted within 1 m after PCI. Results The percentage of patients with grade 0 and grade 1 of TIMI flow grading decreased, and percentage of patients with grade 3 increased in group A and group B after treatment (all P<0.05). The percentage of patients with grade 3 of TIMI flow grading increased in group A compared with group B (76.0% vs. 52.0%, P<0.05). The indexes of LVEF, LVESD and LVEDD were improved in 2 groups after treatment (all P<0.05). The indexes of LVEF, LVESD and LVEDD were improved more significantly in group A compared with group B (all P<0.05). The incidence of adverse cardiovascular events was 4.0% in group A and 16.0% in group B (P<0.05). Conclusion The whole-dose tirofiban combining clopidogrel has more advantages than half-dose tirofiban combining clopidogrel in treatment of NSTE-ACS during perioperative period, which is more effective in improving heart function and blood flow and reducing incidence of adverse cardiovascular events with higher safety. It is well worth clinical application.