急诊PCI术中冠状动脉内应用不同药物对急性ST段抬高型心肌梗死患者心肌灌注效果分析

Effect of tirofiban intracoronary drugs on myocardial perfusion in patients with acute st-segment elevation myocardial infarction during emergency PCI

摘要:

目的 分析急诊经皮冠脉介入术（PCI）中冠状动脉内应用不同药物对急性ST段抬高型心肌梗死患者术后心肌灌注效果的作用。方法 选取2016年2月—2018年12月徐州医科大学附属医院心血管内科收治的急性ST段抬高型心肌梗死患者120例，随机分为两组。研究组采用急诊PCI术联合冠状动脉内应用替罗非班，对照组采用急诊PCI术联合冠状动脉内应用尿激酶。比较两组治疗后心肌再灌注指标、心功能指标、心血管意外事件。结果 研究组患者CK-MB峰值、CK-MB峰值时间低于对照组（P <0.05），研究组患者一氧化氮NO水平优于对照组（P <0.05）。研究组患者TIMI血流分级优于对照组（P <0.05）。研究组患者ST段回降率优于对照组（P <0.05）。研究组患者LVEF、LVEDV、LVESV均优于对照组（P <0.05）。研究组患者的sICAM-1、sVCAM-1、vWF、hs-CRP均低于对照组（P <0.05）。研究组患者术后30 d的心血管不良事件发生率低于对照组（P <0.05）。结论 急诊PCI术中采用冠状动脉内用药，相较于传统尿激酶，替罗非班有利于改善心脏灌注效果，提升心功能评分并降低心血管不良事件的发生率，其安全性与稳定性较好，有利于改善患者的临床疗效与预后。

Abstract:

Objective To analyze the effect of different intracoronary drugs on myocardial perfusion in patients with acute ST-segment elevation myocardial infarction after emergency PCI.Methods Totally 120 patients with acute ST-segment elevation myocardial infarction admitted to the Affiliated Hospital of Xuzhou Medical University in recent two years were selected and randomly divided into two groups. The study group was treated with emergency PCI combined with tirofiban intracoronary medication, while the control group was treated with emergency PCI combined with urokinase intracoronary medication; the indexes of myocardial reperfusion and cardiac function were measured after treatment. Cardiovascular accidents were monitored and the differences between groups were statistically analyzed.Result The peak time of CK-MB and CK-MB in the study group were significantly lower than those in the control group, and the NO level in the study group was significantly better than that in the control group, with significant difference between the two groups (P < 0.05). TIMI blood flow staging in the study group was significantly better than that in the control group, with significant difference between the two groups (P < 0.05). The reduction of ST segment in the study group was significantly better than that in the control group, with significant difference between the two groups (P < 0.05). LVEF, LVEDV, and LVESV in the study group were significantly better than those in the control group (P < 0.05). The levels of sICAM-1, sVCAM-1, vWF and hs CRP in the study group were lower than those in the control group (P < 0.05). The incidence of cardiovascular adverse events at 30 days after surgery was lower in the study group than in the control group (P < 0.05).Conclusion Compared with the traditional emergency PCI alone, tirofiban as an intracoronary drug in emergency PCI can improve the effect of cardiac perfusion, improve the cardiac function score, and reduce the occurrence of cardiovascular adverse events. Its safety and stability are better, and ultimately improve the clinical effect and prognosis. It is suggested that further large-sample study and clinical promotion should be carried out.