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目的研究冠状动脉内注射替罗非班在急性ST段抬高型心肌梗死(STEMI)冠脉介入手术治疗(PCI)中对血流动力学的影响。方法选取2011年11月至2012年11月在本院进行PCI术治疗的506例急性ST段抬高型心肌梗死例患者,用随机数字法分为试验组和对照组各253例。对照组于术中经动脉鞘管注射普通肝素5000 U,术后再皮下注射低分子肝素5000 U,连续5 d;试验组于PCI术前,注射替罗非班5μg·kg~(-1),3 min内注射完毕,随后以0.15μg·kg~(-1)·min~(-1)持续泵入36 h。观察治疗前后2组的血流情况、心脏功能指标以及再灌注指标变化情况。结果治疗前,2组患者经溶栓治疗后血流分级(TIMI)比较差异无统计学意义(P>0.05)。治疗后与治疗前比较,2组患者的TIMI均明显改善(P<0.05),但试验组明显优于对照组(P<0.05)。治疗前,2组患者射血分数(LEVF)分别为(43.11±3.25)%,(42.69±3.22)%、左心室舒张末期内径(LVEDD)分别为(41.05±3.22)mm,(41.09±3.31)mm、左心室收缩末期内径(LVESD)分别为(31.66±4.65),(31.05±4.59)mm,2组比较差异无统计学意义(P>0.05);治疗后与治疗前比较,2组的各项心脏功能指标均明显改善,但试验组的LEVF值为(58.14±6.85)%明显高于对照组(46.12±4.15)%,而LVEDD为(43.11±3.12)mm、LVESD为(34.01±5.17)mm明显低于对照组(49.79±4.52)mm,(39.88±5.13)mm(P<0.05)。患者动脉血流量分级在90 min ST段回落>50%的CK-MB峰值以及CK-MB峰值时间等各项指标,试验组均明显优于对照组(P<0.05)。结论 STEMI在PCI中,冠状动脉内注射替罗非班可有效改善患者血流动力学,并使心功能得到较好地恢复。
Objective To investigate the effect of intracoronary injection of tirofiban on hemodynamics in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Methods A total of 506 patients with acute ST-elevation myocardial infarction who underwent PCI in our hospital from November 2011 to November 2012 were divided into two groups (n = 253) by random number method. The control group received intraoperative arterial sheath injection of unfractionated heparin 5000 U and subcutaneously injected with low molecular weight heparin 5000 U for 5 days. The rats in test group were injected with tirofiban 5 μg · kg -1 , 3 minutes after the injection was completed, followed by continuous infusion of 0.15μg · kg -1 (-1) min -1 for 36 h. The blood flow, cardiac function and reperfusion index were observed before and after treatment. Results Before treatment, there was no significant difference in blood flow classification (TIMI) between the two groups after thrombolytic therapy (P> 0.05). After treatment, the TIMI in both groups were significantly improved (P <0.05), but the experimental group was significantly better than the control group (P <0.05). Before treatment, the ejection fraction (LEVF) of the two groups were (43.11 ± 3.25)% and (42.69 ± 3.22)% respectively, and the left ventricular end diastolic diameter (LVEDD) were (41.05 ± 3.22) mm and (41.09 ± 3.31) mm and LVESD were (31.66 ± 4.65) and (31.05 ± 4.59) mm, respectively. There was no significant difference between the two groups (P> 0.05). After treatment, (58.14 ± 6.85)% in the experimental group was significantly higher than that in the control group (46.12 ± 4.15)%, while the LVEDD was (43.11 ± 3.12) mm and the LVESD was (34.01 ± 5.17) mm significantly lower than that of the control group (49.79 ± 4.52) mm and (39.88 ± 5.13) mm respectively (P <0.05). The arterial blood flow in 90 min ST-segment depression> 50% CK-MB peak and CK-MB peak time and other indicators of the experimental group were significantly better than the control group (P <0.05). Conclusion STEMI can improve the hemodynamics and improve the cardiac function in patients undergoing coronary intervention by intracoronary injection of tirofiban.