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目的观察急性冠脉综合征(ACS)患者择期PCI术后使用替罗非班对围术期不同时间点心脏标记物、血小板聚集率的变化规律以及对PCI术后半年临床疗效及预后的影响。方法选择2009年1月至2011年12月焦作市人民医院心内科住院ACS择期PCI术患者116例,随机分为替罗非班组和对照组。两组患者术前均常规使用阿司匹林和氯吡格雷治疗,替罗非班组患者于PCI术后给予替罗非班并持续至少36 h。观察院内实验室检查结果,住院期间主要不良心脏事件(心源性死亡、再发心绞痛、再次血管重建、心肌梗死)及并发症(主要是出血)的发生情况;随访半年再入院率、主要不良心脏事件的发生情况。结果术后6、24、48 h,替罗非班组血小板聚集率显著低于术前及对照组(P<0.01);术后替罗非班组cTnT(20%vs 62%,P<0.05)和CK-MB(17%vs 56%,P<0.05)增高均低于对照组;替罗非班组住院期间及随访6个月主要不良心脏事件发生率明显低于对照组,差异有统计学意义(P<0.05);随访6个月替罗非班组再入院率低于对照组。结论使用替罗非班可以明显降低血小板聚集率,减少ACS择期PCI术后心肌标记物(cTnT、CK-MB)的升高,减少患者术后住院期间及随访6个月主要不良心脏事件的发生,降低再入院率且安全性良好。
Objective To observe the changes of cardiac markers and platelet aggregation rate at different time points after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), and the effect of tirofiban on the clinical efficacy and prognosis in six months after PCI. Methods One hundred and sixteen patients hospitalized with ACS undergoing PCI in Jiaozuo People’s Hospital from January 2009 to December 2011 were randomly divided into two groups: tirofiban group and control group. Both groups were routinely treated with aspirin and clopidogrel preoperatively and tirofiban was given to tirofiban group for at least 36 h after PCI. Observe the results of in-hospital laboratory tests, major adverse cardiac events during hospitalization (cardiogenic death, recurrent angina, revascularization, myocardial infarction) and complications (mainly bleeding); Follow-up Six months of readmission, major adverse effects The occurrence of a heart attack. Results After 6, 24, and 48 h, the platelet aggregation rate in tirofiban group was significantly lower than that in preoperative and control groups (P <0.01); after tirofiban, cTnT (20% vs 62%, P <0.05) (17% vs 56%, P <0.05). The incidence of major adverse cardiac events during hospitalization and at 6 months of follow-up in the Tirofiban group was significantly lower than that in the control group (the difference was statistically significant ( P <0.05). After 6 months of follow-up, the readmission rate to tirofiban group was lower than that of control group. Conclusion The use of tirofiban can significantly reduce the platelet aggregation rate and reduce the increase of myocardial markers (cTnT, CK-MB) after ACS elective PCI, and reduce the incidence of major adverse cardiac events during the postoperative hospitalization and follow-up of 6 months , Reduce readmission rates and have good safety.