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目的:探讨急性心肌梗死(AMI)急诊直接经皮冠状动脉介入治疗(PCI)术中应用血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班对冠状动脉微血管功能不全和早期左心室重构的影响。方法:104例AMI接受急诊直接PCI患者随机分成治疗组(替罗非班)52例和对照组52例。比较两组术后即刻心肌梗死溶栓治疗临床试验(TIMI)分级、计算校正TIMI计帧数(cTFC)和心肌Blush分级。采用彩色多普勒心动超声仪分别于发病后早期(<24小时即基线)、1、2、3周末连续测量、计算左心室形态、构型等多项指标。结果:两组患者中TIMI3级血流无显著差异(P>0.05),而治疗组中cTFC显著低于对照组(P<0.05),心肌Blush分级获得率比对照组显著增高(P<0.05)。对照组左心室形态和构型变化比治疗组显著加重(P<0.05),且1周末到3周末呈进行性加重,3周末最明显。结论:AMI患者急诊直接PCI术中应用替罗非班可有效改善PCI术后微血管功能不全,对左心室重构有显著抑制作用。
Objective: To investigate the effect of tirofiban on platelet glycoprotein Ⅱb / Ⅲa receptor antagonist in patients with acute myocardial infarction (AMI) undergoing direct percutaneous coronary intervention (PCI) for coronary microvascular insufficiency and early left ventricular remodeling influences. Methods: One hundred and forty-four AMI patients receiving emergency PCI were randomly divided into treatment group (tirofiban) 52 cases and control group 52 cases. TIMI grade was compared between the two groups immediately after myocardial infarction to calculate corrected TIMI frame count (cTFC) and myocardial Blush classification. Color Doppler echocardiography was used to measure the morphology and configuration of the left ventricle in the early post-morbid period (<24 hours baseline) and at the end of 1, 2 and 3 weeks respectively. Results: There was no significant difference in TIMI3 flow between the two groups (P> 0.05), while the cTFC in the treatment group was significantly lower than that in the control group (P <0.05). The Blush grading rate of myocardium was significantly higher than that of the control group (P <0.05) . The morphology and configuration of the left ventricle in the control group were significantly worse than those in the treatment group (P <0.05), and gradually increased from the end of 1 week to the end of 3 weeks and the most obvious at the end of 3 weeks. Conclusion: The application of tirofiban in emergency PCI in AMI patients can effectively improve the microvascular insufficiency after PCI and significantly inhibit left ventricular remodeling.