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目的探讨急性心肌梗死(AMI)急诊冠状动脉介入(PCI)术中应用血小板糖蛋白(glycoprotein,GP)Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班的临床价值及血清黏附分子变化。方法选择急诊入院69例AMI患者,随机分为替罗非班组(盐酸替罗非班加PCI术,32例)和对照组(PCI术,37例),均于发病12h内行急诊PCI术。收集所有病例的临床和冠状动脉造影资料,观察两组PCI术后即刻梗死相关血管(IRA)(TIMI分级)血流情况、术后30d内出血并发症、主要不良心脏事件(MACE)的发生情况及血清黏附分子变化。结果替罗非班组TIMI 3级血流为90.6%(29/32),对照组为78.3%(29/37),差异有统计学意义(P<0.05);主要不良心脏事件的发生率替罗非班组为6.25%(2/32),对照组为16.2%(6/37),差异有统计学意义(P<0.05);出血并发症发生率两组比较差异无统计学意义(P>0.05);观察住院期间替罗非班组无再梗死及死亡病例,对照组梗死及死亡发生率为6.25%(2/32),差异有统计学意义(P<0.05);血清中可溶性细胞间黏附分子-1(sICAM-1)和血管细胞黏附分子-1(sVCAM-1)水平两组比较差异有统计学意义(P<0.05)。结论在AMI急诊PCI术中应用盐酸替罗非班能改善急性心肌梗死患者PCI术后梗死相关血管的TIMI血流,减少PCI术后主要不良心脏事件的发生率,同时明显降低血清黏附分子,减少急性血栓发生率。
Objective To investigate the clinical value and clinical significance of tirofiban hydrochloride, a glycoprotein (GP Ⅱb / Ⅲa) receptor antagonist, for acute coronary intervention (AMI) in acute myocardial infarction (AMI). Methods Sixty-nine patients with acute myocardial infarction (AMI) admitted to our hospital were randomly divided into two groups: Tirofiban (32 cases) and Tirofiban plus (37 cases). All patients underwent emergency PCI within 12 hours. The clinical and coronary angiographic data of all cases were collected. The blood flow of IRI (TIMI grading) immediately after PCI, the bleeding complications within 30 days after operation, the incidence of major adverse cardiac events (MACE) Serum adhesion molecule changes. Results TIMI grade 3 blood flow was 90.6% (29/32) in the tirofiban group and 78.3% (29/37) in the control group, the difference was statistically significant (P <0.05). The incidence of major adverse cardiac events The incidence of hemorrhagic complications was no significant difference between the two groups (P> 0.05), but the difference was statistically significant (P <0.05) ). There were no cases of reinfarction and death in the tirofiban group during hospitalization. The incidence of infarction and death in the control group was 6.25% (2/32), with significant difference (P <0.05). Serum soluble intercellular adhesion molecule 1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1) were significantly different between the two groups (P <0.05). Conclusions The application of tirofiban hydrochloride in AMI emergency PCI can improve the TIMI blood flow of infarction-related blood vessels after PCI in patients with acute myocardial infarction, reduce the incidence of major adverse cardiac events after PCI, and at the same time, significantly reduce serum adhesion molecules and decrease Acute thrombosis.