Objective To investigate the effects of tirofiban combined with metoprolol on hemodynamics and serum levels of C-reactive protein (CRP) and matrix metalloproteinase-9 (MMP-9) in patients with acute myocardial infarction (AMI).Methods 82 patients with AMI treated at our hospital from December,2013 to June,2016 were randomly divided into a control group and a study group,41 for each group.Both groups were treated with conventional anticoagulant thrombolytic therapy and expansion of coronary artery after admission;on the basis of this,the control group were treated with metoprolol for 7 d and the study group with metoprolol and tirofiban (continuously pumping for 36 h).The clinical efficacy,incidence of adverse reactions,hemodynamic parameters [mean pulmonary artery pressure (mPAP),mean mitral pressure difference (mMVP)] at the time of admission and after the treatment,and the serum levels of CRP and MMP-9 were statistically compared between the two groups after the treatment.Results The total effective rate was higher in the study group than in the control group [92.68％ (38/41) vs.(68.29％,28/41)],with a statistical difference (P ＜0.05).The rnPAP and mMVP and the serum levels MMP-9 and CRP were lower after than before the treatment in both groups and were lower in the study group than in the control group after the treatment,with statistical differences (all P ＜0.05).There was no significant difference in the incidence of adverse reactions between the study group and the control group [9.76％ (4/41) vs.12.20％ (5/41),P ＞ 0.05].Conclusions Tirofiban combined with metoprolol for acute myocardial infarction is effective and safe and can effectively reduce the average pulmonary pressure and mitral valve pressure difference,improve hemodynamic status,and decrease the serum levels of MMP-9 and CRP,so it is worth being generalized.%目的 探讨替罗非班联合美托洛尔对急性心肌梗死(AMI)患者血流动力学及血清C反应蛋白(CRP)、基质金属蛋白酶-9(MMP-9)水平变化的影响.方法 选取2013年12月至2016年6月本院82例AMI患者,随机数字表法分为对照组与研究组,各41例;入院后给予两组常规抗凝溶栓治疗及扩张冠状动脉治疗,在此基础上对照组仅采用美托洛尔(持续服用7d)治疗,研究组采用美托洛尔+替罗非班(持续泵入36 h)联合治疗;疗程结束后统计对比两组临床疗效、不良反应发生率、入院时及疗程结束后血流动力学指标[肺动脉平均压(mPAP)、平均二尖瓣压力差(mMVP)]及血清CRP、MMP-9水平变化情况.结果 两组治疗总有效率比较,研究组为92.68％(38/41),高于对照组的68.29％(28/41),差异有统计学意义(P＜0.05);治疗后两组mPAP、mMVP较治疗前降低,且研究组低于对照组,差异均有统计学意义(均P＜ 0.05);治疗后两组血清MMP-9及CRP水平较治疗前降低,且研究组低于对照组,差异均有统计学意义(均P＜ 0.05);两组不良反应发生率比较,研究组为9.76％(4/41),与对照组的12.20％(5/41)比较,差异无统计学意义(P＞0.05).结论 采用美托洛尔及替罗非班联合治疗急性心肌梗死效果显著,可有效减小肺动脉平均压及二尖瓣压力差,改善血流动力学状态,降低血清MMP-9、CRP水平,提高治疗效果,且具有安全性,值得推广.
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