本文選題：替羅非班 + 急性心肌梗死��； 參考：《中國藥房》2017年20期

【摘要】：目的:觀察經(jīng)皮冠狀動脈介入治療(PCI)術(shù)前應(yīng)用替羅非班對急性心肌梗死患者相關(guān)指標的影響。方法:采用回顧性分析方法,選取2015年1月-2016年6月我院收治的急性心肌梗死患者128例,根據(jù)患者PCI術(shù)前是否應(yīng)用替羅非班分為觀察組(76例)和對照組(52例)。對照組患者PCI術(shù)前給予阿司匹林腸溶片300 mg,po+硫酸氫氯吡格雷片600 mg,po,術(shù)中給予肝素鈉注射液100 U/kg,iv。觀察組患者在對照組基礎(chǔ)上于術(shù)前給予鹽酸替羅非班氯化鈉注射液0.2μg/(kg·min),iv。觀察兩組患者術(shù)后ST段回落情況、胸痛改善情況,術(shù)前心肌酸激酶同工酶(CK-MB)水平和術(shù)后CK-MB峰值、達峰時間和持續(xù)時間,術(shù)后心肌梗死溶栓治療(TIMI)血流分級,術(shù)前術(shù)后血管性假血友病因子(v WF)、血漿內(nèi)皮素1(ET-1)和血清一氧化氮(NO)水平,并記錄不良反應(yīng)發(fā)生情況。結(jié)果:PCI術(shù)后,觀察組患者ST段回落率(89.47%)明顯高于對照組(67.31%),胸痛總緩解率(89.47%)明顯高于對照組(75.00%),TIMI血流分級2~3級的患者明顯多于對照組,差異均有統(tǒng)計學意義(P0.05)。PCI術(shù)前,兩組患者CK-MB、v WF、ET-1和NO水平比較,差異均無統(tǒng)計學意義(P0.05);PCI術(shù)后,觀察組患者CK-MB峰值、達峰時間和持續(xù)時間均明顯低于或短于對照組;兩組患者v WF和ET-1水平均明顯降低,NO水平明顯升高,且觀察組患者v WF、ET-1和NO水平的改善程度明顯優(yōu)于對照組,差異均有統(tǒng)計學意義(P0.05)。觀察組患者輕度出血發(fā)生率明顯低于對照組,中度出血發(fā)生率明顯高于對照組,差異均有統(tǒng)計學意義(P0.05);但兩組患者死亡率比較,差異均無統(tǒng)計學意義(P0.05)。結(jié)論:PCI術(shù)前應(yīng)用替羅非班可緩解患者臨床癥狀,改善心功能,保護血管內(nèi)皮,恢復(fù)冠狀動脈血流灌注,但應(yīng)注意其出血風險。
[Abstract]:Aim: to observe the effect of tirofiban on the indexes of patients with acute myocardial infarction (AMI) before percutaneous coronary intervention (PCI). Methods: by retrospective analysis, 128 patients with acute myocardial infarction admitted in our hospital from January 2015 to June 2016 were divided into observation group (n = 76) and control group (n = 52) according to whether tirofiban was used before PCI. Patients in control group were treated with aspirin enteric-coated tablets (300mg / g) po hydroclopidogrel sulfate (600mg / kg) before operation and heparin sodium injection (100U / kg / kg) intraoperatively. The patients in the observation group were given tirofiban hydrochloride sodium chloride injection 0. 2 渭 g/(kg / min before operation on the basis of the control group. The postoperative St segment depression, chest pain improvement, cardiac acid-kinase isoenzyme CK-MBs, peak CK-MB, peak time and duration, blood flow grade of thrombolytic therapy after myocardial infarction were observed in both groups. Before and after operation, the levels of von Willebrand factor v WFI, plasma endothelin 1 (et 1) and serum nitric oxide (no) were recorded, and the adverse reactions were recorded. Results the St segment fall rate (89.47%) in the observation group was significantly higher than that in the control group (67.31%) and the total relief rate of chest pain (89.47 7) in the observation group was significantly higher than that in the control group (75.00%) and the TIMI blood flow grade (2 擄3) was significantly higher in the observation group than in the control group. The difference was statistically significant before PCI. There was no significant difference in the levels of CK-MBV WFFT-1 and no between the two groups after PCI. The peak value, peak time and duration of CK-MB in the observation group were significantly lower than those in the control group. The levels of vWF and ET-1 in the two groups were significantly lower than those in the control group, and the levels of vWF ET-1 and no in the observation group were significantly higher than those in the control group (P 0.05). The incidence of mild hemorrhage in the observation group was significantly lower than that in the control group, and the incidence of moderate hemorrhage in the observation group was significantly higher than that in the control group, and the difference was statistically significant (P 0.05), but there was no significant difference in the mortality between the two groups (P 0.05). Conclusion tirofiban before PCI can relieve clinical symptoms, improve cardiac function, protect vascular endothelium and restore coronary blood flow perfusion, but the risk of bleeding should be paid attention to.
【作者單位】： 齊齊哈爾醫(yī)學院附屬第二醫(yī)院心血管內(nèi)科;齊齊哈爾醫(yī)學院附屬第二醫(yī)院神經(jīng)內(nèi)科;
【分類號】：R542.22

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