血栓抽吸联合替罗非班对急性心肌梗死血栓病变患者心功能及预后的影响Observation of thrombus aspiration combined tirofiban on heart function and prognosis in patients of acute myocardial infarction with thrombosis
王立新,王建斌,杨丽,李富军,赵宇,何晓雷,颜翠萍
摘要(Abstract):
目的探讨血栓抽吸联合替罗非班对急性心肌梗死血栓病变患者心功能及预后的影响。方法选取北京市延庆县医院收治的372例急性ST段抬高心肌梗死(STEMI)患者为观察对象,随机分为观察组(183例)和对照组(189例),观察组患者在常规经皮冠状动脉介入治疗(PCI)基础上采用血栓抽吸联合替罗非班治疗,对照组进行常规PCI,比较两组患者治疗效果、术后并发症以及不良反应等。结果观察组中术后TIMI血流分级Ⅲ级患者152例(83.1%),高于对照组的140例(74.1%),观察组血流改善情况与对照组比较,差异有统计学意义(P<0.05);观察组患者术后7、30 d时左心室射血分数(LVEF)分别为(60.4±6.1)%、(64.3±5.6)%,高于对照组的(52.4±5.9)%、(55.4±5.7)%,差异有统计学意义(P<0.05);观察组患者中出血36例(19.7%),对照组患者中出血26例(13.8%),两组患者出血发生率比较,差异无统计学意义(P>0.05);观察组患者中30 d内主要不良心脏事件(MACE)10例(5.5%),对照组30 d内MACE 22例(11.6%),两组患者比较,差异有统计学意义(P<0.05);两组患者均未发生血小板减少症。结论血栓抽吸联合替罗非班应用于急性心肌梗死血栓病变PCI中,可显著改善术后冠状动脉的血流灌注,提高近期左心室射血功能,降低30 d内MACE发生率。
关键词(KeyWords): 急性心肌梗死;血管成形术;经皮冠状动脉介入治疗;血栓抽吸
基金项目(Foundation):
作者(Author): 王立新,王建斌,杨丽,李富军,赵宇,何晓雷,颜翠萍
参考文献(References):
- [1]万方,张拓,沈玲红,等.急性ST段抬高心肌梗死溶栓后早期介入治疗与直接介入治疗的对比研究.中国介入心脏病学杂志,2013,21:3-7.
- [2]Serruys PW,Morice MC,Kappetein AP,et al.Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease.N Engl J Med,2009,360:961-972.
- [3]Amato JL Jr,Shamoon FE,Haft JI.Thrombusaspiration during Primary percutaneous coronary intervention.N Engl J Med,2008,358:2640-2641.
- [4]俎德玲,诸葛毅,蒋一鸣,等.急性心肌梗死患者血小板活化标志物与超微结构的变化.中华急诊医学杂志,2011,20:76-77.
- [5]沈法荣,钟诚.心肌梗死诊断标准心电图变化最新指南解读.心电学杂志,2010,29:88-89.
- [6]替罗非班治疗冠状动脉粥样硬化性心脏病专家共识组.替罗非班在冠状动脉粥样硬化性心脏病治疗的中国专家共识.中华内科杂志,2013,52:434-439.
- [7]Mehta NN,Yu YD,Pinnelas R,et al.Attributable risk estimate of severe psoriasis on major cardiovascular events.Am J Med,2011,124:775.e1-e6.
- [8]刘智芬.血小板参数和高敏C反应蛋白在急性心肌梗死患者中的临床意义.河北医药,2011,33:1856-1857.
- [9]Antoniucci D.Rheolytic thrombectomy in acute myocardial infarction:the Florence experience and objectives of the multicenter randomized JETSTTENT trial.J Invasive Cardiol,2006,18 Suppl C:32C-34C.
- [10]李蕾,韩江莉,李海燕,等.抗血小板药物抵抗对急性心肌梗死患者再发心脏缺血事件的预测价值.中华医学杂志,2012,92:2677-2680.
- [11]Kushner FG,Hand M,Smith SC Jr,et al.2009 Focused Updates:ACC/AHA Guidelines for the Management of Patients With STElevation Myocardial Infarction(Updating the 2004 Guideline and 2007 Focused Update)and ACC/AHA/SCAIGuidelines on Percutaneous Coronary Intervention(Updatingthe 2005 Guideline and 2007 Focused Update)A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation,2009,120:2271-2306.
- [12]李南,祖晓麟,颜红兵.替罗非班在急性非ST段抬高心肌梗死介入治疗中的安全性和有效性.第二军医大学学报,2010,10:524-526.