本文選題：急性心肌梗死 + 替羅非班��； 參考：《大連醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的評價半量替羅非班與肝素聯(lián)合應(yīng)用在急性心肌梗死(Acute myocardialinfarction，AMI)急診冠脈介入治療術(shù)中的療效及安全性。 方法 1.病例的篩選及分組：本課題采用隨機對照的方法，收集2011年5月至2013年1月在遼寧省人民醫(yī)院住院治療，且符合納入標(biāo)準(zhǔn)、排除標(biāo)準(zhǔn)的急性心肌梗死并接受急診介入治療的患者。將95例患者隨機分為兩組，全量組：全量替羅非班＋70iu/kg肝素；半量組：半量替羅非班＋100iu/kg肝素。其中全量組50例，平均年齡53.42±11.41歲，半量組45例，平均年齡49.57±11.68歲。 2.給藥方法：兩組患者術(shù)前均給予負(fù)荷量拜阿司匹林300mg、氯吡格雷300mg、阿托伐他汀40mg口服。全量組冠脈造影前靜脈給予肝素2500iu，PCI時按總量追加肝素，同時給予負(fù)荷量替羅非班10ug/kg，3分鐘內(nèi)推入，繼而以0.15ug/(kg·min)持續(xù)泵入36小時；半量組冠脈造影前靜脈給予肝素2500iu，PCI時追加肝素，同時給予負(fù)荷量替羅非班10ug/kg，3分鐘內(nèi)推入，繼而以0.075ug/(kg·min)持續(xù)泵入36小時。術(shù)后36小時兩組均開始應(yīng)用磺達肝癸鈉2.5mg/日，同時常規(guī)應(yīng)用拜阿司匹林100mg/日、氯吡格雷75mg/日、阿托伐他汀20mg/日、比索洛爾2.5mg/日及硝酸脂類藥物。 3.冠脈造影及冠狀介入治療：由經(jīng)驗豐富的醫(yī)師對患者行冠脈造影術(shù)，同時對梗塞相關(guān)動脈行PCI術(shù)。 4.觀察指標(biāo)：心肌梗死溶栓試驗血流分級(Thrombolysis In MyocardialInfarction，TIMI)，心肌組織灌注水平（TIMI myocardial perfusion grading，，TMPG）方法，校正的TIMI血流幀計數(shù)（Corrected TIMI Frame Count， CTFC），2小時內(nèi)ST段回落情況，術(shù)后1周EF值；住院期間的主要MACE事件、TIMI出血及血小板減少并發(fā)癥。 5.數(shù)據(jù)處理：數(shù)據(jù)采用spss13.0軟件進行統(tǒng)計學(xué)分析，計數(shù)資料統(tǒng)計描述采用率或構(gòu)成比表示，統(tǒng)計學(xué)分析采用X2檢驗或Fisher確切概率法；計量資料統(tǒng)計描述采用均數(shù)±標(biāo)準(zhǔn)差表示，統(tǒng)計分析采用兩個獨立樣本的t檢驗，以P0.05為有統(tǒng)計學(xué)意義。 結(jié)果 1.兩組患者在性別、年齡、高血壓、糖尿病、高血脂、抽煙、飲酒、BMI等基礎(chǔ)資料均無統(tǒng)計學(xué)差異。 2.兩組患者冠脈造影結(jié)果：術(shù)后TIMI3級比較，差異無統(tǒng)計學(xué)意義（86.0%VS82.2%， P=0.614）；術(shù)后TMP3級比較，差異無統(tǒng)計學(xué)意義（74.0%VS71.1%，P=0.753）；兩組患者PCI術(shù)中CTFC計數(shù)比較，差異無統(tǒng)計學(xué)意義（29.65±4.53VS30.80±3.42，P=0.674）； 3.兩組患者臨床資料比較：術(shù)后兩小時ST段回落≥50%比率無統(tǒng)計學(xué)差異（90.0%VS88.9%，P=0.860）；全量組與半量組患者術(shù)后1周的EF值無統(tǒng)計學(xué)差異（0.51±0.06VS0.49±0.06，P=0.583）。 4.住院期間主要心血管不良事件：全量組發(fā)生死亡1例，死于心源性休克，半量組無死亡；靶血管重建全量組0例，半量組1例，兩組之間無顯著差異。 5.住院期間出血及血小板減少情況：全量組發(fā)生牙齦出血4例，穿刺部位血腫3例，消化道出血1例，經(jīng)積極止血治療后未出現(xiàn)嚴(yán)重并發(fā)癥，半量組鼻粘膜出血2例，皮膚黏膜1例，穿刺部位出血1例，全量組出血率高于半量組差異有統(tǒng)計學(xué)意義（p0.05）；兩組患者均未發(fā)生血小板減少。 6.兩組患者的住院費用(35988yuan±6580.93VS33629±4174.04yuan，P=0.042)及住院天數(shù)（8.54±2.59天VS7.84±2.81天， P=0.544）。 結(jié)論 1.半量組與全量組在改善術(shù)后TIMI血流、術(shù)后TMP血流、CTFC方面無顯著性差異。 2.半量組與全量組住院期間主要MACE事件的發(fā)生率及血小板減少的發(fā)生率無明顯差異。 3.與全量組相比，半量組出血并發(fā)癥少且住院費用低。
[Abstract]:Objective to evaluate the efficacy and safety of the combined use of semi - tirofiban and heparin in the emergency coronary intervention for acute myocardial infarction (Acute myocardialinfarction, AMI).
Method
The screening and grouping of 1. cases: a randomized controlled method was used to collect hospitalized treatment in Liaoning people's Hospital from May 2011 to January 2013, and to meet the standard, exclude the standard acute myocardial infarction and receive emergency intervention treatment. 95 patients were randomly divided into two groups, full measure: tirofiban + 70iu/kg Heparin, half dose group: half dose tirofiban + 100iu/kg heparin, total volume 50 cases, mean age 53.42 + 11.41 years, half volume group 45 cases, average age 49.57 + 11.68 years old.
2. the method of administration: the two groups were given a load of aspirin 300mg, clopidogrel 300mg, atorvastatin 40mg orally. The whole group was given heparin 2500iu before the total coronary angiography, PCI was added to the total heparin at the time of PCI, and the load of tironon class 10ug/kg was given in 3 minutes, and then continuously pumped with 0.15ug/ (kg min) for 36 hours. In the half volume group, heparin 2500iu, PCI heparin was added to the anterior vein of coronary angiography, and the load was given for Luo Fei class 10ug/kg, 3 minutes was pushed into the group, and then 0.075ug/ (kg. Min) was pumped continuously for 36 hours. 36 hours after the operation, two groups began to apply sulfononura 2.5mg/ day, routine application of aspirin 100mg/ day, clopidogrel 75mg/ day. Atorvastatin 20mg/ days, bisoprolol 2.5mg/ days and nitrates.
3. coronary angiography and coronary intervention: experienced doctors performed coronary angiography and PCI for infarct related artery.
4. observation index: Thrombolysis In MyocardialInfarction (TIMI), myocardial perfusion level (TIMI myocardial perfusion grading, TMPG), corrected TIMI blood flow frame count (Corrected TIMI), 2 hours decline, 1 weeks postoperatively; ACE events, TIMI bleeding and thrombocytopenia complications.
5. data processing: the data are statistically analyzed by SPSS13.0 software, the statistical description of the adoption rate or the ratio of composition is expressed, the statistical analysis uses X2 test or the exact probability of Fisher; the statistical description of the measurement data is represented by the mean mean deviation of the mean number, and the statistical analysis uses the t test of the independent samples, with the P0.05 as the statistics. Significance.
Result
1. there was no statistically significant difference in gender, age, hypertension, diabetes, hyperlipidemia, smoking, drinking, BMI and so on between the two groups.
2. the results of coronary angiography in the 2. two groups: the difference was not statistically significant (86.0%VS82.2%, P=0.614) after the operation (86.0%VS82.2%, P=0.614), and the difference was not statistically significant (74.0%VS71.1%, P=0.753) after the operation (74.0%VS71.1%, P=0.753). The difference of CTFC count in the two groups was not statistically significant (29.65 + 4.53VS30.80 + 3.42, P=0.674).
3. the clinical data of the two groups were compared: there was no statistical difference (90.0%VS88.9%, P=0.860) at two hours after two hours after the operation (90.0%VS88.9%, P=0.860), and there was no statistical difference (0.51 + 0.06VS0.49 + 0.06, P=0.583) at 1 weeks after operation in the whole group and the half volume group.
4. the main cardiovascular adverse events during the hospitalization: 1 cases of death in the whole group, death from cardiogenic shock and no death in the half volume group; 0 cases of total target vessel reconstruction and 1 cases in the half volume group. There was no significant difference between the two groups.
5. bleeding and thrombocytopenia during hospitalization: 4 cases of gingival bleeding in the whole group, 3 cases of hematoma in puncture site, 1 cases of hemorrhage in digestive tract, no serious complications after active hemostasis, 2 cases of nasal mucous bleeding in half volume group, 1 cases of skin mucosa and 1 cases of puncture site bleeding, and the difference of total bleeding rate was higher than that of half volume group (P 0.05); there were no thrombocytopenia in the two groups.
6. the hospitalization expenses of the two groups of patients (35988yuan + 6580.93VS33629 + 4174.04yuan, P=0.042) and length of stay (8.54 + 2.59 days VS7.84 + 2.81 days, P=0.544).
conclusion
1. half volume group and total volume group had no significant difference in improving TIMI blood flow, postoperative TMP blood flow and CTFC.
2. there was no significant difference in the incidence of major MACE events and the incidence of thrombocytopenia in the half volume group and the full volume group during hospitalization.
3. compared with the full dose group, the half volume group had less bleeding complications and lower hospitalization expenses.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R542.22

【參考文獻】

相關(guān)期刊論文 前10條

1 沈杰;沈衛(wèi)峰;;替羅非班在急性冠脈綜合征介入治療中的應(yīng)用[J];國際心血管病雜志;2006年03期

2 荊素敏;陳魁;何飛;姜正明;張雅娉;李蕾;黃彥兵;;替羅非班應(yīng)用于急性冠狀動脈綜合征患者不同時機的安全性和有效性[J];臨床心血管病雜志;2010年06期

3 董鵬;張萌;劉軍杰;曲濤;靳維華;王斌;;替羅非班和尿激酶在急診PCI術(shù)中抗血栓作用的比較[J];中國臨床醫(yī)學(xué);2009年04期

4 譚莉麗;周永紅;蘭希福;任書亭;王曉偉;;缺血性中風(fēng)急性期證型與血管假性血友病因子血栓素B_2及6-酮-前列環(huán)素F_(lα)的相關(guān)性研究[J];遼寧中醫(yī)雜志;2010年06期

5 張孝忠;張軍;王紅;張晉;蔣靜;;國產(chǎn)替羅非班在急性冠脈綜合征介入治療中應(yīng)用的安全性及長期療效觀察[J];中國全科醫(yī)學(xué);2010年05期

6 王東;張成;杜新平;左國興;陳書中;;冠狀動脈內(nèi)注入替羅非班治療急性冠脈綜合征介入術(shù)后無復(fù)流的臨床研究[J];實用心腦肺血管病雜志;2008年04期

7 陳躍峰,楊躍進;經(jīng)皮冠狀動脈介入治療術(shù)后的無再流現(xiàn)象[J];心血管病學(xué)進展;2005年01期

8 徐立;楊新春;;替羅非班在急性ST段抬高心肌梗死急診介入治療中的應(yīng)用[J];心血管病學(xué)進展;2007年04期

9 張之瀛;耿濤;張建剛;宋志遠(yuǎn);彭萬忠;馬增才;徐澤升;;急性心肌梗死患者血小板活化程度及其臨床意義[J];疑難病雜志;2008年12期

10 汪衛(wèi)東;李麗;李永忠;;急性ST段抬高型心肌梗死早期伴發(fā)束支傳導(dǎo)阻滯對患者預(yù)后的影響[J];疑難病雜志;2009年09期

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