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目的:评价急性心肌梗死患者直接经皮冠状动脉介入治疗(PCI)术前应用国产血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂——替罗非班对术后临床预后的影响。方法:接受直接PCI的75例ST段抬高型心肌梗死(STEMI)患者随机分为替罗非班组(38例)和对照组(37例),比较2组间的基础临床状况、造影情况、介入治疗结果,随访1年,比较2组间的心绞痛复发率、主要心脏不良事件(MACE)发生率及左心室射血分数(LVEF)。结果:2组间的基础临床状况差异无统计学意义(P>0.05)。替罗非班组术前梗死相关动脉(IRA)心肌梗死溶栓治疗临床试验(TIMI)3级血流比例较对照组明显增多(73.7%比48.6%,P<0.05),但术后2组TIMI3级血流比率差异无统计学意义(92.1%比89.1%,P>0.05)。替罗非班组术后1年心绞痛复发率(5.3%比24.3%,P<0.05)、MACE发生率(7.9%比27.0%,P<0.05)显著降低,LVEF明显升高(58.1±6.2比50.4±9.6,P<0.05)。结论:国产替罗非班能显著减少急性心肌梗死患者直接PCI术后1年内心绞痛的复发,明显降低主要MACE的发生,并改善左心室功能,对临床预后有益。
Objective: To evaluate the effect of preoperative application of domestic platelet glycoprotein (GP Ⅱb / Ⅲa receptor antagonist - tirofiban) on postoperative clinical outcome in patients with acute myocardial infarction undergoing direct percutaneous coronary intervention (PCI). Methods: Seventy-five patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI were randomly divided into tirofiban group (n = 38) and control group (n = 37). The baseline clinical conditions, The outcome of interventional therapy was followed up for 1 year. The recurrence rate of angina pectoris, incidence of major adverse cardiac events (MACE) and left ventricular ejection fraction (LVEF) were compared between the two groups. Results: There was no significant difference in basic clinical status between the two groups (P> 0.05). Tirofiban group was significantly higher than the control group (73.7% vs. 48.6%, P <0.05), but the postoperative TIMI3 level was significantly higher in the TIMI group than in the control group There was no significant difference in grade flow rate (92.1% vs. 89.1%, P> 0.05). The recurrence rate of angina pectoris (5.3% vs 24.3%, P <0.05) and the incidence of MACE (7.9% vs. 27.0%, P <0.05) were significantly lower in the tirofiban group at 1 year after operation and the LVEF was significantly higher (58.1 ± 6.2 vs 50.4 ± 9.6, P <0.05). Conclusion: Domestic tirofiban can significantly reduce the recurrence of angina pectoris in patients with acute myocardial infarction within one year after direct PCI, significantly reduce the occurrence of major MACE and improve left ventricular function, which is beneficial to the clinical prognosis.