| 孙江丽,张晓平.替罗非班不同给药途径联合血栓抽吸对急性ST段抬高型心肌梗死病人预后的影响:一项随机、对照、开放研究[J].安徽医药,2020,24(9):1850-1855. |
| 替罗非班不同给药途径联合血栓抽吸对急性ST段抬高型心肌梗死病人预后的影响:一项随机、对照、开放研究 |
| Effects of different administration routes of tirofiban combined with thrombus aspiration on prognosis of patients with acute ST-segment elevation myocardial infarction: a randomized，controlled and open-label study |
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| DOI：10.3969/j.issn.1009-6469.2020.09.040 |
| 中文关键词: 心肌梗死 栓子清除术 抽吸 心电描记术 投药途径 替罗非班 预后 |
| 英文关键词: Myocardial infarction Embolectomy Suction Electrocardiography Drug administration routes Tirofiban Prognosis |
| 基金项目:2014年度河南省医学科技攻关计划项目( 201403247) |
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| 中文摘要: |
| 目的研究替罗非班不同给药途径联合血栓抽吸对急性 ST段抬高型心肌梗死( STEMI)病人预后的影响。方法将 2014年 3月至 2017年 3月三门峡市中心医院高血栓负荷的 247例 STEMI病人采用随机数字表法分为 A(静脉注射)、 B(梗阻冠脉开口处注射)、 C(梗阻冠脉远端注射)三组采用替罗非班联合血栓抽吸辅助经皮冠状动脉介入治疗( PCI)比较三组 PCI后心肌梗死溶栓试验( TIMI)血流分级水平、心肌灌注分级( TMPG)、校正的 TIMI血流帧数计数( CTFC)、 ST段回落，率以及心功能状况，并随访三组 PCI后 1年内主要不良心血管事件( MACE)发生率。结果 PCI后三组 TIMI血流分级水平差异有统计学意义(χ2＝10.592，P＝0.005)，C组Ⅲ级血流比例为 47例( 56.63%)高于 A组 27例( 34.78%)和 B组 31例( 33.82%)差异有统计学意义( P＜0.05)；三组 TMPG分别为( 2.19±0.38)级、(2.31±0.45)，级和( 2.53±0.47)级， CTFC分别为( 26.34±3.72)帧、(，27.08± 3.84)帧和( 28.45±3.91)帧， ST段回落率分别为( 72.53±12.64)%、(76.29±13.42)%和( 83.65±14.78)%，三组 TMPG、CTFC和 ST段回落率比较差异有统计学意义( F＝12.918、6.444、14.136，P＝0.000、0.002、0.000)且 C组 TMPG、CTFC和 ST段回落率高于 A、B两组，差异有统计学意义( P＜0.05)；治疗后 30 d时三组左室射血分数( LVEF)明高，左室舒张末期内径( LVEDD)、左室收缩末期内径( LVESD)明显降低( P＜0.05)三组治疗后各指标差异有统计学意义( P＜0.05)；且 C组 LVEF高于 A、B两组， LVEDD和 LVESD低于 A、B两组，差异有学意义( P＜0.05)； PCI术中常见不良反应包括胸痛、心律失常、 VRRs及充血性心力衰竭，三组比较均差异无统计学意义( P＞0.05)；随访 1年时间显示，三组 MACE发生率分别为 21例( 25.61%)、 16例显升，统计，(19.51%)和 5例( 6.02%)差异有统计学意义( χ2＝11.759，P＝0.003)且 C组 MACE发生率低于 A、B两组，差异有统计学意义(P＜0.05)。结论 PCI术中血栓抽吸后梗阻冠脉远端注射替罗非治疗 STEMI可有效改善病人 TIMI血流分级水平，提高 TMPG、CTFC和 ST段回落率，促进病人心功能恢复，并降低治疗后 MACE发生率，改善病人预后，疗效明显优于静脉注射和梗班，阻冠脉开口处给药。 |
| 英文摘要: |
| Objective To study the effects of different administration routes of tirofiban combined with thrombus aspiration on theprognosis of patients with acute ST-elevation myocardial infarction(STEMI).Methods Two hundred and forty-seven cases of STEMIpatients with high thrombotic load in Sanmenxia Central Hospital from March 2014 to March 2017 were divided into group A(in- travenous injection)，group B(injection at the opening of obstructed coronary artery)and group C(injection at distal obstructed coronary artery)according to the random number table method，and the three groups were given tirofiban combined with thrombus aspiration assisted percutaneous coronary intervention(PCI).The thrombolysis in myocardial infarction(TIMI) test blood flow grade，TIMI myocardial perfusion grade(TMPG)，corrected TIMI frame count(CTFC)，ST-segment fall rate and cardiac function status were compared among the three groups after PCI，and the occurrence of major adverse cardiac events(MACE)within 1 year after PCI were followed up in the three groups.Results After PCI，there was a significant difference in TIMI blood flow grade level among the three groups(χ2＝10.592，P＝0.005)，and the proportion of grade III blood flow in group C was higher than that in group A and B［47 cases(56.63%)vs. 27 cases(34.78%)vs. 31 cases(33.82%)］( P＜0.05).The TMPG values in the three groups were(2.19±0.38)，(2.31±0.45)and(2.53±0.47)，and the CTFC values were(26.34±3.72)frames，(27.08±3.84)frames and(28.45±3.91) frames，respectively，and the ST-segment fall rates were(72.53±12.64)%，(76.29±13.42)% and(83.65±14.78)%，respectively，and there were statistically significant differences in the TMPG，CTFC and ST-segment fall rate among the three groups(F＝12.918，6.444，14.136，P＝0.000，0.002，0.000)，and the TMPG，CTFC and ST-segment fall rate in group C were higher than those in group A and B(P＜0.05).At 30d after treatment，left ventricular ejection fraction(LVEF)increased signifi- cantly while left ventricular end-diastolic diameter(LVEDD)and left ventricular end-systolic diameter(LVESD)decreased signifi- cantly in the three groups(P＜0.05)， and the difference in each index after treatment was significant(P＜0.05).The LVEF in group C was higher than that in group A and B while the LVEDD and LVESD were lower than those in group A and B(P＜0.05). Common adverse reactions during PCI included chest pain，arrhythmia，VRRs and congestive heart failure，and there were no signifi- cant differences among the three groups(P＞0.05).One year of follow-up showed there was a significant difference in the inci- dence rate of MACE among the three groups［ 21 cases(25.61%)vs. 16 cases(19.51%)vs. 5 cases(6.02%)］( χ2＝11.759，P＝0.003)，and the incidence rate of MACE in group C was lower than that in group A and B(P＜0.05).Conclusions Tirofiban in- jection at distal obstructed coronary artery after thrombus aspiration during PCI for STEMI can effectively improve TIMI blood flowgrade，increase the TMPG，CTFC and ST-segment fall rate，promote cardiac function recovery，reduce the incidence rate of MACE after treatment，and improve the prognosis of patients.And its efficacy is significantly better than that of intravenous injection anddrug administration at the opening of obstructed coronary artery. |
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