纤溶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：探讨纤溶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：120例老年急性心肌梗死患者随机分成两组，对照组和观察组各60例。所有患者均进行经皮冠脉介入术（PCI），对照组术后静滴重组组织型纤溶酶原激活剂（rt—PA），观察组则联合使用rt-PA和替罗非班。比较术前及术后两组间冠脉微循环功能和凝血功能差异。结果：术后2h，观察组QTd间期明显短于对照组，声学峰值强度（PI）、曲线下面积（AUC）大于对照组，ST段下降幅度大于对照组，酶峰时间短于对照组，差异具有统计学意义（P〈0．05）；术后4h，观察组凝血酶时间（TT）、凝血酶原时间（PT）、部分凝血活酶时间（APTT）、纤维蛋白原（Fb）明显长于对照组，血清D-二聚体（D—D）水平明显高于对照组，血清纤维蛋白原（Fig）水平低于对照组，差异具有统计学意义（P〈0．05）；术后4h，观察组的纤溶酶原（PLG）、α2-纤溶酶抑制物（a2一PI）、纤溶酶原激活物抑制剂（PAI-1）低于对照组，组织型纤溶酶原激活物（t-PA）则高于对照组，差异具有统计学意义（P〈0．05）。结论：纤溶酶联合替罗非班能有效改善老年急性心肌梗死患者微循环及凝血状态，有利于患者的康复。

Influence of rt-PA combined with tirofiban for the microcirculation and coagulation of elderly patients with acute myocardial infarction

Objective： To observe the influence of recombinant tissue-type plasminogen activator （rt-PA） with tirofiban for the microcirculation and coagulation of elderly patients with acute myocardial infarction（AMI） combining Methods .. A total of 120 cases patients with AMI were randomly divided into control group and observation group, with 60 cases in each group,all the patients were given percutaneous coronary intervention and treated with rt-PA, patients in observation group were treated by tirofiban and rt-PA, while the control group given rt-PA alone. Then the indexes of coronary microcirculation and coagulation of two groups were compared. Results： 2 hours after PCI, the QTd interval and enzyme-peak hours of observation group were shorter than control group, PI and AUC were larger than control group, ST segment decline was significantly greater than control group （ P all〈0.05）. 4 hours after undergoing PCI, TT, PT, APTT, Fb of observation group were all significantly longer than control group, the serum level of D-D was higher than control group, while the Fig was lower than control group （P all〈0.05）. 4 hours after PCI, PLG, a2-PI, PAI-lof observation group were all significantly lower than control group, the serum level of t-PA was higher than control group （P all〈0.05）. Oonclusion：Rt-PA combined with tirofibanfor can effectively improve the microcirculation and coagulation in elderly patients with acute myocardial infarction, and is beneficial for patients＇ recovery.