急诊经皮冠状动脉介入治疗术中应用血栓抽吸联合替罗非班治疗对炎性反应因子的影响

 目的 探讨急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中应用血栓抽吸联合替罗非班的临床疗效及对炎性反应因子表达水平的影响。方法 选取2015-04至2017-03收治的220例急性心肌梗死患者,按随机数字表法分为研究组和对照组,每组110例。对照组采用PCI治疗联合血栓抽吸。研究组PCI治疗联合血栓抽吸并在术前静脉滴注替罗非班。观察两组术后即刻冠状动脉血流情况(TIMI)变化。检测两组术前和术后24 h的CRP、IL-6、TNF-α、cTnI、BNP水平。观察两组术后即刻心电图ST段回落≥50%发生率、术后LVEF、出院时Killip分级。结果 术后即刻研究组TIMI血流分级明显优于对照组,差异有统计学意义(P＜0.05);术后24 h研究组CRP(10.17±1.39)mg/L]、IL-6(21.85±2.97)mg/L]、TNF-α(41.35±4.70)ng/L]明显低于对照组的(11.64±1.73)mg/L、(25.01±3.27)mg/L、(37.96±3.81)ng/L],差异有统计学意义(P＜0.05);术后24 h研究组cTnI、BNP均低于对照组,差异有统计学意义(P＜0.05);研究组患者出院时心电图ST段回落≥50%发生率(65.45%)、LVEF(56.39±5.13)、Killip分级均优于对照组,差异有统计学意义(P＜0.05)。结论 替罗非班能进一步降低急诊血栓抽吸PCI患者炎性反应因子的分泌,减轻心肌细胞损伤,改善血流灌注状态。

Clinical efficacy of tirofiban combined with thrombus aspiration in emergency PCI patients and the influence on inflammatory factors

Objective To investigate the clinical efficacy of thrombus aspiration combined with tirofiban in emergency percutaneous coronary intervention (PCI) and its effect on the expression of inflammatory factors in patients. Methods Two hundred and twenty patients with acute myocardial infarction were divided into the study group and the control group. The control group was treated with thrombus aspiration combined with PCI while the study group was additionally given intravenous drip of tirofiban. TIMI blood flow grading changes were detected in both groups. The levels of CRP, IL-6, TNF-α, cTnI and BNP were detected in the two groups before and 24 hours after operation. Clinical outcome indexes of the two groups were observed: the incidence of immediate postoperative ST segment of electrocardiograms that decreased by more than 50%, postoperative LVEF, and Killip grade at discharge. Results The TIMI blood flow grade of the two groups improved significantly, especially in the control group. The difference was statistically significant (P＜0.05). 24 hours after operation, the levels of CRP, IL-6 and TNF- alpha of the two groups decreased significantly. The difference was statistically significant (P＜0.05). CRP(10.17±1.39)mg/L, IL-6(21.85±2.97)mg/L and TNF- alpha(41.35±4.70)ng/L in the study group were lower than those in the control group(11.64±1.73)mg/L,(25.01±3.27)mg/L,and 37.96±3.81)ng/L. 24 hours after operation, cTnI and BNP of the two groups were significantly reduced, especially in the study group. The difference was statistically significant (P＜0.05). The incidence of adverse cardiovascular events in the study group was lower than that in the control group. When the patients in the study group were discharged from hospital, the incidence of ST segment of electrocardiograms decreased by more than 50%(65.45%), while LVEF(56.39±5.13)and Killip grades were better than those in the control group(50.91%、46.72±4.05), the difference was statistically significant (P＜0.05). Conclusions Tirofiban can further reduce the secretion of inflammatory factors, alleviate myocardial injury and improve blood flow perfusion in emergency PCI patients.