半负荷量替罗非班对急性STEMI患者急诊PCI术治疗后心肌生化标志物的影响分析

摘要

目的 探讨半负荷量替罗非班对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)治疗后心肌生化标志物的影响.方法 选取2012年11月至2015年11月接受急诊PCI治疗的STEMI患者218例为研究对象,根据术前是否应用替罗非班分为治疗组(应用替罗非班,108例)与对照组(未应用替罗非班110例).分别在两组患者手术前及术后48 h对患者的肌钙蛋白、肌酸激酶、氨基末端B 型脑钠肽(NT-proBNP)水平进行测定,并对两组患者在发病24 h内及术后60 d的心功能指标进行评估.观察两组患者在住院期间及术后90 d内不良心脏事件(MACE)及出血并发症的发生情况.结果 与手术前比较,手术后48 h治疗组与对照组患者的肌钙蛋白、肌酸激酶、NT-pro-BNP水平均显著升高,且对照组在手术后48 h各指标水平升高更显著(P<0.05);治疗组发病24 h内及术后60 d心功能指标左心室收缩末期容积(LVESV)、左心室舒张末期容积(LVEDV)均低于对照组,而左心室射血分数(LVEF)高于对照组(P<0.05);治疗组发生MACE5例(4.65%),出血并发症2例(1.85%),对照组发生MACE12例(10.91%),出血并发症1例(0.91%),治疗组MACE发生率明显较对照组低(P<0.05),两组出血并发症发生率差异无显著性(P>0.05).结论 半负荷量替罗非班可有效降低急性STEMI患者急诊PCI术后心肌生化标志物水平,并能改善短期预后,值得临床推广应用.%Objective To explore the influence of half load Tirofiban on myocardial biochemical marker of emergency PCI patients with acute STEMI.Methods From November 2012 to November 2015, 218 cases of STEMI patients received emergency PCI treatment were selected as the research object, according to the use of tirofiban before surgery, they were divided into treatment group (108 cases of tirofiban) and control group (110 cases), respectively.Troponin creatine kinase, amino terminal B type natriuretic peptide (NT-proBNP) levels before and after operation of 48 h were measured, and the cardiac function indexes of two groups in 24h and 60d after operation were evaluated.Adverse cardiac events (MACE) and the incidence of bleeding complications were observed during hospitalization and postoperative 90 d.Results Compared with before surgery, troponin, creatine kinase, NT-pro-BNP levels in postoperative 48h treatment group and the control group were significantly increased, andthe indexes in the control group at 48h after operation were significantly higher (P<0.05);LVESV and LVEDV within 24h and postoperative 60din treatment group were lower than those of the control group, and LVEF was higher than that of the control group (P<0.05).The treatment group occurred MACE 5 cases (4.65%), 2 cases of bleeding complications occurred in the control group (1.85%), MACE12 (10.91% cases), 1 cases of bleeding complications (0.9 1%), the incidence of MACE in the treatment group was significantly lower than that in the control group (P<0.05), and the incidence of bleeding complications in the two groups was not significantly different (P>0.05).Conclusion Half dose tirofiban can effectively reduce the level of myocardial biochemical markers in patients with acute STEMI after emergency PCI, and can improve the short-term prognosis, which is worthy of clinical application.