瑞替普酶联合替罗非班对老年急性心肌梗死患者微循环及凝血状态的影响

目的：观察瑞替普酶联合替罗非班对老年急性心肌梗死患者微循环及凝血状态的影响。方法：将180例老年急性心肌梗死患者随机分为两组,对照组和观察组各90例。其中对照组采用瑞替普酶治疗,观察组则采用瑞替普酶联合替罗非班治疗。比较治疗前后两组间冠脉微循环相关指标差异、凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、Fb及血清D-二聚体（D-D）、纤维蛋白酶原（Fig）、抗凝血酶-Ⅲ（AT-Ⅲ）、蛋白C（PC）、纤溶酶原活性（PLG）。结果：观察组治疗后第4、24小时ST段下降幅度、AUC大于对照组,QTd间期短于对照组,PI强于对照组,到达酶峰时间亦高于对照组,差异具有统计学意义（P〈0.05）;治疗后4、24h观察组TT、PT、APTT、Fb长于对照组,血清D-D水平高于对照组,而血清Fig、AT-Ⅲ、PC和PLG水平低于对照组,差异具有统计学意义（P〈0.05）。结论：瑞替普酶联合替罗非班能有效促进老年急性心肌梗死患者微循环和凝血功能的改善,有利于缺血心肌血流供应的恢复,减少心肌损伤和梗死面积。

Influence of reteplase combining with tirofiban for the microcirculation and coagulation of elderly patients with acute myocardial infarction

Objective; To observe the influence of reteplase combining with tirofiban for the microcirculation and coagulation of elderly patients with acute myocardial infarction（AMI）. Methods： A total of 180 cases patients with AMI were randomly divided into control group and observation group with 90 cases in each group,all the patients were treated with reteplase, patients in observation group were treated by reteplase combining with tirofiban. Then the indexes of coronary microcirculation and coagulation（TT, PT, APTT and Fb） and the serum levels of D-D, Fig and PC, AT-Ⅲ , PLG of two groups were corn pared. Results：After 4, 24 hours of treatment, the ST segment declined more significantly, and AUC of observation group were larger than control group, QTd interval was shorter, PI was stronger than that of the control group, （P all 〈0.05）. After 4, 24 hours of treatment, TT, PT, APTT, Fb of observation group were all significantly longer than that of control group, the serum level of D-D was higher than control group, while the Fig and PC, AT-Ⅲ, PLG were lower than control group （P all 〈0.05）. Conclusion：Reteplase combining with tirofiban can effectively improve the microcirculation and coagulation of elderly patients with acute myocardial infarction, and conducive to the recovery of blood supply to the ischemic myocardium, and will reduce infarct size and myocardial injury.