氯吡格雷联合替罗非班用于STEMI患者PCI术后的抗血小板治疗及对血清炎症因子的影响

目的分析氯吡格雷联合替罗非班用于急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后的抗血小板治疗及对血清炎症因子的影响。方法回顾性分析2016年5月至2017年5月在西安市国际医学中心医院心内科治疗的127例STEMI患者资料,将其中采用氯吡格雷抗凝的患者63例作为对照组,采用氯吡格雷联合替罗非班抗凝的64例作为观察组,所有患者入院后均给予常规基础治疗,对照组在上述治疗基础上术前给予氯吡格雷300mg,口服,术后继续维持治疗;观察组在对照组基础上给予术中静脉推注替罗非班,维持用药36h,术后继续口服氯吡格雷维持。观察两组患者的抗血小板治疗效果及对血清炎症因子的影响。结果两组患者PCI术前心肌梗死溶栓试验(TIMI)血流分级经比较差异无统计学意义(P>0.05);观察组患者PCI术后TIMI血流分级明显优于对照组,差异有统计学意义(P<0.05)。两组患者PCI术前血小板黏附率及血小板聚集率差异无统计学意义(P>0.05);两组患者PCI术后血小板黏附率及血小板聚集率与术前比较均明显降低(P<0.05),且观察组明显优于对照组(P<0.05)。两组患者治疗后血清中C反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平均较治疗前降低,差异有统计学意义(P<0.05),且观察组降低更加明显(P<0.05);所有患者出院1个月后均定期门诊随访行心脏彩超检查,观察组左室射血分数(LVEF)、左室舒张末期内径(LVEDD)与对照组比较均明显改善,差异有统计学意义(P<0.05);观察组住院期间及出院后1个月内心脑血管不良反应事件发生率明显低于对照组,差异有统计学意义(P<0.05)。结论氯吡格雷联合替罗非班术后可以明显抑制血小板功能,改善心肌再灌注和心功能,减少严重心脑血管不良反应事件的发生,值得推广应用。

Application of clopidogrel combined with tirofiban in postoperative anti-platelet treatment after PCI in STEMI patients and its effect on serum inflammatory factors

Objective To analyze the effect of clopidogrel combined with tirofiban on antiplatelet therapy and serum inflammatory factors after percutaneous coronary intervention(PCI)in the patients with ST segment elevation myocardial infarction(STEMI).Methods The data of 127 patients with STEMI treated in the cardiology of department of the Xi′an Municipal International Medical Center Hospital from May 2016 to may2017 were analyzed retrospectively.Among them,63 cases of clopidogrel anticoagulation treatment served as the control group,and 64 cases of clopidogrel combined with tirofiban anticoagulation served as the observation group.All cases were given the routine basic treatment after admission.The control group was preoperatively given oral clopidogrel 300 mg based on the above treatment,postoperative maintenance treatment;the observation group was intravenously given tirofiban on the basis of the control group,maintenance medication for 36 h,postoperative continuous oral clopidogrel maintenance.The effect of antiplatelet therapy and its influence on serum inflammatory factors were observed in the two groups.Results There was no statistically significant difference in TIMI blood flow classification before PCI between the two groups(P>0.05).The TIMI blood flow classification after PCI in the observation group was significantly superior to the control group with statistical difference(P<0.05).The platelet adhesion rate and platelet aggregation rate before operation had no statistical difference between the two groups(P>0.05);the platelet adhesion rate and platelet aggregation rate after PCI in the two groups were significantly decreased compared with those before PCI(P<0.05),moreover the observation group was significantly better than the control group(P<0.05).The levels of serum CRP,IL-6 and TNF-αafter treatment in the two groups were significantly decreased compared with those before treatment(P<0.05),moreover the decrease in the observation group was more significant(P<0.05);all cases were followed up by color Doppler echocardiography at regular intervals after one month in the outpatients department,LVEF and LVEDD in the observation group were significantly improved compared with the control group,and the difference was statistically significant(P<0.05);the incidence rate of cardiovascular adverse events during hospitalization and within postoperative 1 month after discharge in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Clopidogrel combined with tirofiban can significantly inhibit the platelet function,improve the myocardial reperfusion and cardiac function,and reduce the occurrence of serious cardiovascular adverse events,which is worth popularizing.