急性STEMI病人在PCI术不同时间应用替罗非班对即刻靶血管造影和心肌损伤的影响

摘要

目的：探究急性 ST段抬高型心肌梗死(STEMI)病人在经皮冠脉介入治疗(PCI)术不同时间应用替罗非班对即刻靶血管造影和心肌损伤的影响。方法选取2011年2月—2014年5月武汉大学人民医院行经皮冠脉介入治疗的急性 ST段抬高型心肌梗死病人200例作为观察对象,按照替罗非班应用时机不同分为3组,在抢救室应用替罗非班治疗的95例病人作为观察A组,在导管室应用替罗非班治疗的56例病人作为研究 B组,不使用替罗非班治疗,同时向冠脉内注射等量0.9%氯化钠注射液治疗的49例病人作为对照组,其余调脂、抗凝治疗方式均相同,采用 TIMI血流及心肌灌注分级标准评价病人 PCI治疗前后即刻靶血管造影情况,观察 PCI前后心肌损伤标志物变化、PCI后主要不良心脏事件以及出血并发症和血小板减少症发生率。结果3组病人在 PCI前 TIMI血流分级和心肌灌注分级差异无统计学意义(P>0.05),在 PCI后,3组病人 TIMI血流分级无变化(P>0.05),观察 A组和观察 B组在心肌灌注分级方面优于对照组(P<0.05)；心肌损伤标志物方面,3组病人在 PCI前磷酸肌酸激酶同工酶(CK MB)、肌钙蛋白(cTNT)含量方面差异无统计学意义(P>0.05),在PCI后观察A组、观察B组CK MB含量差异有统计学意义(P<0.05)；3组病人随访半年,在出血并发症、血小板减少症、主要心血管事件(MACE)发生情况差异无统计学意义(P>0.05)。结论 STEMI病人行急诊 PCI早期应用替罗非班治疗可以改善即刻梗死相关动脉的血流和心肌灌注,降低心肌损伤程度,并发症和不良反应可以耐受。%Objective To explore the effects of different time application of tirofiban on immediate targetangiography and myocardial injury in patients with acute ST segment elevation myocardial infarction (STEMI)undergoing percutaneous coronary intervention (PCI). Methods Two hundreds patients with STEMI undergoing PCI were selected in our hospital from February 2011 to May 2014, in accordance with the different time application of tirofiban were divided into three groups,in the resuscitation room of tirofiban in pa-tients with 95 cases as group A,the application of tirofiban therapy in patients with 56 cases as group B,without the use of tirofiban intracoronary injection of equal,at the same time to the 0.9% Sodium Chloride injection treatment in patients with 49 cases as the control group,the remaining lipid,anticoagulation therapy were the same. The immediate target of angiography was evaluated by thrombolysis in myocardial infarction (TIMI)blood flow and myocardial perfusion grading standards. The changes of biochemical markers of myocardial injury were observed before and after PCI. The major adverse cardiovascular events (MACE),bleeding com-plications and the incidence of thrombocytopenia were observed. Results There was no difference in the TIMI flow grade and PCI myocardial perfusion grade among three groups before PCI(P>0.05). After PCI,TIMI flow grades were unchanged in three groups (P>0.05). The myocardial perfusion grades in group A and group B were better than that in control group (P<0.05). There was no difference in the contents of CK MB and cTNT among three groups before PCI(P>0.05). After PCI,There was a difference in the contents of CK MB and cTNT among three groups(P<0.05). After fol ow up for 6 months,There was no difference in the oc-currence of bleeding,thrombocytopenia,MACE among three groups(P>0.05). Conclusion Early application of tirofiban in patients with STEMI undergoing emergency PCI can improve the immediate infarction related artery blood flow and myocardial perfusion,re-duce the degree of myocardial injury,complications,and adverse reactions could be tolerated.