替罗非班联合替格瑞洛和阿司匹林在老年急性心肌梗死急诊经皮冠状动脉介入治疗中的临床疗效
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摘要
目的观察对于老年急性心肌梗死(AMI)患者采取急诊经皮冠状动脉介入(PCI)治疗中采用替罗非班联合替格瑞洛和阿司匹林治疗的临床疗效分析。方法选取2016年1月—2017年12月在郑州市第一人民医院急诊科确诊为急性心肌梗死行急诊PCI治疗的老年患者138例,根据PCI围术期治疗药物不同将患者分为观察组69例和对照组69例,对照组患者术前均给予负荷量阿司匹林300 mg及替格瑞洛180 mg嚼服,观察组在此基础上加用替罗非班术前以0.4 U/(kg·min)速度静脉泵入30 min,术后以0.1 U/(kg·min)的速度持续泵入24～36 h,术后两组均常规口服阿司匹林和替格瑞洛,至术后12个月。对比两组患者临床治疗效果、安全性及心肌酶标志物与超声检查。结果观察组患者无复流、慢血流、主要不良心脏事件(MACE)发生率明显少于对照组,TIMI3及ST段回落几率高于对照组,观察组心肌酶标志物酸激酶同工酶(CK-MB)浓度峰值时间、左室射血分数(LVEF)及左室舒张末内径(LVEDd)结果明显优于对照组,差异均具有统计学意义(P<0.001)。治疗后两组血清超敏C-反应蛋白(hs-CRP)和白介素-6(IL-6)水平均显著降低(P<0.05);且治疗后观察组hs-CRP、IL-6均显著低于对照组(P<0.05)。两组均未出现严重出血,两组出血发生率比较差异无统计学意义;两组非心源性呼吸困难发生率比较差异无统计学意义,入组患者均未因上述不良反应而停用抗血小板药物。结论对于老年AMI患者采取急诊PCI术时,应用替罗非班联合替格瑞洛和阿司匹林治疗,可有效减少无复流或慢血流的发生几率,改善心肌灌注功能,不增加出血风险,减少主要不良心脏事件发生。
Objective To observe the clinical efficacy of tiglilo and tirofiban in elderly patients with acute myocardial infarction(AMI) treated by emergency percutaneous coronary intervention(PCI). Methods 138 elderly patients with acute myocardial infarction diagnosed as acute myocardial infarction in emergency department of Zhengzhou First People's Hospital from January2016 to December 2017 were selected and divided into experimental group(69 cases) and control group(69 cases) according to the different drugs used during the perioperative period of PCI. All patients were given 300 mg aspirin and 180 mg tegrilo chewing before admission, and the observation group was given replacement on this basis. Rofiban was pumped intravenously at a speed of0.4 U/(kg?min) for 30 minutes before operation and continuously at a speed of 0.1 U/(kg?min) for 24-36 hours after operation. The patients in the two groups were followed up for 3 months. The clinical efficacy, safety, myocardial enzyme markers and ultrasonography were compared between the two groups. Results The incidence of no-reflux, slow blood flow and MACE in the experimental group was significantly less than that in the control group. The probability of TIMI3 and ST segment falling was higher than that in the control group. The peak time of CK-MB concentration and the results of LVEF and LVEDd in the experimental group were significantly better than those in the control group, with statistical significance(P < 0.001). There was no significant difference in serum hs-CRP and IL-6 levels between the two groups before treatment. After treatment, the levels of hs-CRP and IL-6 in the experimental group were significantly lower than those in the control group(P < 0.05). Conclusion Tiglilo combined with tirofiban can effectively reduce the incidence of no-reflow or slow blood flow, improve myocardial perfusion function, increase the risk of bleeding and reduce the occurrence of major adverse cardiac events in elderly patients with AMI undergoing emergency PCI.
Objective To observe the clinical efficacy of tiglilo and tirofiban in elderly patients with acute myocardial infarction(AMI) treated by emergency percutaneous coronary intervention(PCI). Methods 138 elderly patients with acute myocardial infarction diagnosed as acute myocardial infarction in emergency department of Zhengzhou First People's Hospital from January2016 to December 2017 were selected and divided into experimental group(69 cases) and control group(69 cases) according to the different drugs used during the perioperative period of PCI. All patients were given 300 mg aspirin and 180 mg tegrilo chewing before admission, and the observation group was given replacement on this basis. Rofiban was pumped intravenously at a speed of0.4 U/(kg?min) for 30 minutes before operation and continuously at a speed of 0.1 U/(kg?min) for 24-36 hours after operation. The patients in the two groups were followed up for 3 months. The clinical efficacy, safety, myocardial enzyme markers and ultrasonography were compared between the two groups. Results The incidence of no-reflux, slow blood flow and MACE in the experimental group was significantly less than that in the control group. The probability of TIMI3 and ST segment falling was higher than that in the control group. The peak time of CK-MB concentration and the results of LVEF and LVEDd in the experimental group were significantly better than those in the control group, with statistical significance(P < 0.001). There was no significant difference in serum hs-CRP and IL-6 levels between the two groups before treatment. After treatment, the levels of hs-CRP and IL-6 in the experimental group were significantly lower than those in the control group(P < 0.05). Conclusion Tiglilo combined with tirofiban can effectively reduce the incidence of no-reflow or slow blood flow, improve myocardial perfusion function, increase the risk of bleeding and reduce the occurrence of major adverse cardiac events in elderly patients with AMI undergoing emergency PCI.
引文
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[7]魏雪梅,朱庆华,谷世奎,等.替格瑞洛在氯吡格雷抵抗急性心肌梗死患者PCI术后抗血小板治疗中的应用效果[J].山东医药, 2015, 55(15):46-47,48.
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[10] Zhu L H, Sun L H, Hu Y L, et al. PCAF impairs endometrial receptivity and embryo implantation by down-regulatingβ3-integrin expression via HOXA10acetylation[J]. J Clin Endocrinol Metab, 2013, 98(11):4417-4428.
[11] Steg P G, James S, Harrington R A, et al. Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention[J].Circulation, 2010, 122(21):2131-2141.
[12] Chalouhi N, Jabbour P, Daou B, et al. A new protocol for anticoagulation with tirofiban during flow diversion[J].Neurosurgery, 2016, 78(5):670-674.
[13] Cohen M. Antiplatelet therapy in percutaneous coronary intervention:A critical review of the 2007 AHA/ACC/SCAI guidelines and beyond[J]. Cathet Cardiovasc Intervent, 2009, 74(4):579-597..
[14]张健发,于雁飞,黄定,等.替格瑞洛联合替罗非班在ST段抬高型心肌梗死糖尿病患者急诊PCI术中的应用和安全性[J].中国老年学杂志, 2017, 37(5):1098-1101.
[2] Levine G N, Bates E R, Blankenship J C, et al. 2015ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with STelevation myocardial infarction:an update of the 2011ACCF/AHA/SCAI Guideline for percutaneous coronary intervention and the 2013 ACCF/AHA/SCAI Guideline for the management of ST-elevation myocardial infarction[J]. Am Coll Cardiol, 2016, 67(10):1235-1250.
[3] Storey R. Pharmacology and clinical trials of reversiblybinding P2Y12inhibitors[J]. Thromb Haemost, 2011, 105(S 06):S75-S81.
[4] Wang K, Zuo G X, Zheng L Y, et al. Effects of tirofiban on platelet activation and endothelial function in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention[J]. Cell Biochem Biophys, 2015, 71(1):135-142.
[5]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志, 2015, 43(5):380-393.
[6] James S,?kerblom A, Cannon C P, et al. Comparison of ticagrelor, the first reversible oral P2Y12receptor antagonist, with clopidogrel in patients with acute coronary syndromes:Rationale, design, and baseline characteristics of the PLATelet inhibition and patient Outcomes(PLATO)trial[J]. Am Heart J, 2009, 157(4):599-605.
[7]魏雪梅,朱庆华,谷世奎,等.替格瑞洛在氯吡格雷抵抗急性心肌梗死患者PCI术后抗血小板治疗中的应用效果[J].山东医药, 2015, 55(15):46-47,48.
[8] Zanatta A, Rocha A M, Carvalho F M, et al. The role of the Hoxa10/HOXA10 gene in the etiology of endometriosis and its related infertility:a review[J]. J Assist Reprod Genet, 2010, 27(12):701-710.
[9] Alysson Z, Pereira R M A, Rocha A M D, et al. The relationship among HOXA10, estrogen receptorα,progesterone receptor, and progesterone receptor B proteins in rectosigmoid endometriosis:a tissue microarray study[J]. Reprod Sci, 2015, 22(1):31-37.
[10] Zhu L H, Sun L H, Hu Y L, et al. PCAF impairs endometrial receptivity and embryo implantation by down-regulatingβ3-integrin expression via HOXA10acetylation[J]. J Clin Endocrinol Metab, 2013, 98(11):4417-4428.
[11] Steg P G, James S, Harrington R A, et al. Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention[J].Circulation, 2010, 122(21):2131-2141.
[12] Chalouhi N, Jabbour P, Daou B, et al. A new protocol for anticoagulation with tirofiban during flow diversion[J].Neurosurgery, 2016, 78(5):670-674.
[13] Cohen M. Antiplatelet therapy in percutaneous coronary intervention:A critical review of the 2007 AHA/ACC/SCAI guidelines and beyond[J]. Cathet Cardiovasc Intervent, 2009, 74(4):579-597..
[14]张健发,于雁飞,黄定,等.替格瑞洛联合替罗非班在ST段抬高型心肌梗死糖尿病患者急诊PCI术中的应用和安全性[J].中国老年学杂志, 2017, 37(5):1098-1101.