血栓抽吸联合替罗非班对急性心肌梗死血栓病变患者心功能及预后的影响

摘要

目的：探讨血栓抽吸联合替罗非班对急性心肌梗死血栓病变患者心功能及预后的影响。方法选取北京市延庆县医院收治的372例急性ST段抬高心肌梗死（STEMI）患者为观察对象，随机分为观察组（183例）和对照组（189例），观察组患者在常规经皮冠状动脉介入治疗（PCI）基础上采用血栓抽吸联合替罗非班治疗，对照组进行常规PCI，比较两组患者治疗效果、术后并发症以及不良反应等。结果观察组中术后TIMI血流分级Ⅲ级患者152例（83.1%），高于对照组的140例（74.1%），观察组血流改善情况与对照组比较，差异有统计学意义（P＜0.05）；观察组患者术后7、30 d时左心室射血分数（LVEF）分别为（60.4±6.1）%、（64.3±5.6）%，高于对照组的（52.4±5.9）%、（55.4±5.7）%，差异有统计学意义（P＜0.05）；观察组患者中出血36例（19.7%），对照组患者中出血26例（13.8%），两组患者出血发生率比较，差异无统计学意义（P＞0.05）；观察组患者中30 d内主要不良心脏事件（MACE）10例（5.5%），对照组30 d内MACE 22例（11.6%），两组患者比较，差异有统计学意义（P＜0.05）；两组患者均未发生血小板减少症。结论血栓抽吸联合替罗非班应用于急性心肌梗死血栓病变PCI中，可显著改善术后冠状动脉的血流灌注，提高近期左心室射血功能，降低30 d内MACE发生率。%Objective To evaluate the prognestic effect of thrombus aspiration combined tirofiban in patients of acute myocardial infarction. Methods 372 patients with acute ST segment elevation myocardial infarction were randomly divided into the observation group (n=183) and the control group (n=189). Patients in the observation group received thrombus aspiration combined tirofiban additional to conventional treatment, and cases in the control group received routine treatment. The curative effect, postoperative complications and adverse reactions were compared between the 2 groups. Results The postoperative TIMI classⅢperfusion was achieved in 152 cases (83.1%) in the observation group and 140 cases (74.1%) in the control group (P < 0.05). The left heart ejection fraction of the observation group on 7 and 30 days after surgery was (60.4±6.1)%and (64.3±5.6)%respectively which was higher than the control group with (52.4±5.9)% and (55.4±5.7)% on 7 and 30 days respectively (P < 0.05). Bleeding events were recorded in 36 cases(19.7%) in the observation group rensus 26 versus (13.8%) in the control group (P>0.05). MACE reorded within 30 d post operation was 10 cases(5.5%) in the observation group and 22 cases (11.6%) in the control group (P < 0.05). No thrombocytopenia recorded in both groups. Conclusions Thrombus aspiration combined tirofiban for patients with acute myocardial infarction during PCI can improve the postoperative coronary artery perfusion, left ventricular ejection function and reduce the incidence of MACE within 30 days.