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目的探讨冠脉内联合应用替罗非班和山莨菪碱治疗老年急性ST段抬高心肌梗死(ASTEMI)病人的可行性、安全性及临床效果。方法将接受经皮冠状动脉介入(PPCI)治疗的72例老年ASTEMI病人采用随机数字表法均分为观察组和对照组两组,观察组行高剂量替罗非班联合山莨菪碱治疗,对照组行单纯高剂量替罗非班治疗,评价两组间出血风险差异、术后40 d内不良心血管事件(MACE)发生率以及术后1年内左心室射血分数(LVEF);术后随访24~40个月,统计病人年再次住院次数,综合评价治疗效果。结果术后两组病人均无严重出血及血小板减少症状;术后40 d观察组MACE发生率低于对照组(P<0.05);术后12个月两组LVEF比较差异有统计学意义(P<0.01);观察组随访期间年住院次数明显优于对照组(P<0.01)。结论老年ASTEMI病人PPCI时联合使用替罗非班与山莨菪碱可有效改善术后心功能,降低年再次住院次数。
Objective To investigate the feasibility, safety and clinical efficacy of intracoronary tirofiban and anisodamine in the treatment of elderly patients with acute ST-segment elevation myocardial infarction (ASTEMI). Methods Seventy-two elderly ASTEMI patients undergoing percutaneous coronary intervention (PPCI) were randomly divided into two groups: observation group and control group. The observation group was treated with high dose tirofiban combined with anisodamine, Group treated with high-dose tirofiban alone, to assess the difference between the two groups of bleeding risk, adverse cardiovascular events (MACE) within 40 days after surgery and incidence of postoperative left ventricular ejection fraction (LVEF) within 1 year; postoperative follow-up 24 to 40 months, the number of patient re-hospitalization statistics, a comprehensive evaluation of the treatment effect. Results There was no severe hemorrhage and thrombocytopenia in both groups after operation. The incidence of MACE in observation group 40 days after operation was lower than that in control group (P <0.05). There was significant difference in LVEF between the two groups <0.01). The number of hospitalizations during the follow-up period in the observation group was significantly better than that in the control group (P <0.01). Conclusions Combined use of tirofiban and anisodamine in elderly patients with ASTEMI can effectively improve postoperative cardiac function and reduce the number of hospitalizations again in the year.