论文部分内容阅读
目的:探讨直接介入术早期应用不同剂量替罗非班对急性ST段抬高型心肌梗死(STEMI)患者术后的临床疗效。方法:连续入选确诊STEMI行PCI治疗患者,随机分为大剂量组(予替罗非班25μg/kg的负荷剂量静脉推注)、常规剂量组(予替罗非班10μg/kg的负荷剂量静脉推注)及对照组,每组60例。观察术前、术后罪犯血管的TIMI分级血流及心功能[术后住院期间及术后30d左室射血分数(LVEF)、脑利钠肽(BNP)]。对术后住院期间出血事件发生率进行安全性评价。对住院期间及术后30d患者主要不良心脏事件(MACE)进行随访。结果:大剂量组、常规剂量组患者术前罪犯血管的TIMI血流分级均优于对照组(P<0.001,P=0.032),且大剂量组患者术前罪犯血管的TIMI血流分级优于常规剂量组(P=0.037)。3组术后TIMI血流分级及慢血流发生率比较差异无统计学意义。术后心功能显示,住院期间大剂量组和常规剂量组LVEF、BNP较对照组明显改善(P<0.05),且大剂量组较常规剂量组LVEF、BNP改善更明显(P<0.05);3组术后30d的LVEF、BNP比较差异无统计学意义。3组出血事件的发生率比较差异无统计学意义。大剂量组和常规剂量组术后MACE发生率明显低于对照组(P<0.05),而大剂量组与常规剂量组比较差异无统计学意义。结论:急性STEMI患者早期使用替罗非班,可以改善PCI术前TIMI血流分级、早恢复PCI术后住院期间心功能及减少MACE发生率,且上游大剂量应用替罗非班改善术前TIMI血流分级及恢复PCI术后住院期间心功能更加明显。
Objective: To investigate the clinical effect of different doses of tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI) treated by direct interventional therapy. Methods: Patients were enrolled in the study. The patients were randomly divided into high dose group (25mg / kg loading tirofiban intravenous bolus), conventional dose group (10mg / kg loading dose intravenous tirofiban group Bolus) and control group, 60 cases in each group. The TIMI grading blood flow and cardiac function [postoperative hospitalization and postoperative 30 days left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP)] were observed before and after the operation. The safety of postoperative bleeding during hospitalization was evaluated. The main adverse cardiac events (MACE) during hospitalization and postoperative 30d were followed up. Results: TIMI flow classification of preoperative criminals was superior to that of control group (P <0.001, P = 0.032) in high dose group and conventional dose group, and TIMI flow classification of preoperative criminals was superior to high dose group The conventional dose group (P = 0.037). There was no significant difference in TIMI grade and incidence of slow blood flow between the three groups. The postoperative cardiac function showed that LVEF and BNP in high-dose group and conventional dose group were significantly improved (P <0.05), and the improvement of LVEF and BNP in high-dose group was more significant than that in normal group (P <0.05); 3 There was no significant difference in LVEF and BNP between the 30th day and the 30th day after operation. There was no significant difference in the incidence of bleeding among the three groups. The incidence of postoperative MACE in high-dose group and conventional dose group was significantly lower than that in control group (P <0.05), but there was no significant difference between high-dose group and conventional dose group. Conclusion: The early use of tirofiban in patients with acute STEMI can improve TIMI blood flow classification before PCI, early recovery of cardiac function during hospitalization after PCI and reduce the incidence of MACE, and the use of high-dose upstream tirofiban improves preoperative TIMI Grading of blood flow and recovery of cardiac function after PCI was more obvious.