替罗非班对急性心肌梗死行直接冠状动脉介入治疗患者血浆B型脑钠肽及心功能的影响

目的探讨血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班在急性心肌梗死(AMI)患者行直接冠状动脉介入(PCI)治疗后对B型脑钠肽(BNP)及心功能的影响。方法将172例AMI患者随机分为替罗非班组(替罗非班+直接PCI)82例和对照组(直接PCI)90例。比较两组患者术后90 min心电图ST段回落百分比(sum-STR);7 d和30 d的BNP变化;术后7 d及30 d左室射血分数(LVEF)、左室舒张末期内径(LVEDD)和左室收缩末期内径(LVESD)的变化;术后30 d内主要心脏不良事件(心绞痛、心肌梗死、死亡)及出血的发生率。结果两组患者开通梗死相关动脉(IRA)后TIMI 3级血流率比较,差异无统计学意义(P>0.05);术后90 min的sumSTR>50%、IRA无复流发生率比较,差异均有统计学意义(P<0.05);替罗非班组7 d及30 d的血浆BNP水平均明显低于对照组(P<0.01);两组术后24 h及30 d LVEF、LVEDD、LVESD比较,差异均有统计学意义(P<0.01);替罗非班组术后24 h及30 d内主要心脏不良事件发生率低于对照组,差异均有统计学意义(P<0.01);两组出血发生率比较,差异无统计学意义(P>0.05)。结论替罗非班能明显改善AMI患者急诊PCI术后心功能,减少心脏不良事件的发生,急诊PCI应用替罗非班是有效而安全的。

Effect of Tirofiban on the Prognosis of Heart Function and B-type Brain Natriuretic Peptide Levels of Acute Myocardial Infarction Patients Received Primary Percutaneous Coronary Artery Interventional Therapy

Objective To evaluate the effect of Tirofiban on the prognosis of heart function and B-type brain natriuretic peptide(BNP) levels of acute myocardial infarction(AMI) patients who received primary percutaneous coronary artery interventional therapy.Methods 172 AMI patients were randomly divided into Tirofiban group(n=82) and control group(n=90).The resolution of the sum of ST-segment elevation(sumSTR) 90 minutes after the operation was compared between the two groups.The changes of serum BNP levels,left ventricular ejection fraction(LVEF),left ventricular end diastolic dimension(LVEDD) and left ventricular end systolic dimension(LVESD) were measured and compared between the two groups 7 days and 30 days after operation.Major adverse cardiovascular events(MACE) and bleeding complications occurred during hospitalization and 30 days in the following-up period were recorded and compared between the two groups.Results The blood flow rate of TIMI 3 showed no statistically significant difference between the two groups after IRA was opened(P>0.05).Patients received Tirofiban were more likely to achieve higher sumSTR and complete ST resolution 90 minutes after the procedure,the differences between the two groups were statistically significant(P<0.01).The BNP concentration was significantly different between the two groups 7 days and 30 days after treatment(P<0.01).The entries of LVEDD,LVESD and LVEF were significantly increased in Tirofiban group 30 days after PCI(P<0.01).The incidence of MACE was significantly lower in Tirofiban group than that in control group(P<0.01).There was no statistically significant difference in bleeding complications between the two groups(P>0.05).Conclusion Application of Tirofiban in patients accompanied with acute ST elevation myocardial infarction who received primary PCI can effectively and safely improve the heart function of the patients and can reduce adverse events after operation.