替罗非班结合法舒地尔对急性心肌梗死PCI术后凝血纤溶状态、炎症反应及超声心动图参数的影响

张宁; 张庆华; 靳二冬; 李凯; 高雯

doi:10.13898/j.cnki.issn.1000-2200.2023.04.009

替罗非班结合法舒地尔对急性心肌梗死PCI术后凝血纤溶状态、炎症反应及超声心动图参数的影响

Effect of tirofiban combined with fasudil on the coagulation, fibrinolysis, inflammation and echocardiographic parameters after PCI for acute myocardial infarction

摘要

摘要:
目的探讨替罗非班结合法舒地尔对急性心肌梗死(AMI)病人经皮冠状动脉介入治疗(PCI)术后凝血纤溶状态、炎症反应及超声心动图参数的影响。
方法选取接受PCI治疗的AMI病人206例, 以随机数字表法分为观察组和对照组, 各103例。治疗期间对照组使用替罗非班, 观察组在对照组基础上使用法舒地尔。对比2组术后即刻心肌梗死溶栓试验(TIMI)分级、心肌灌注分级(TMPG)、不良反应、术后3个月主要不良心血管事件(MACE)发生情况, 以及术前、术后3 d、术后7 d凝血纤溶指标凝血酶时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、纤溶酶原激活物抑制物-1(PAI-1)、炎症反应指标肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、超敏-C反应蛋白(hs-CRP), 术前、术后7 d超声心动图参数左心室射血分数(LVEF)、心脏指数(CI)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)水平。
结果观察组术后即刻TIMI分级3级率与TMPG分级3级率均较对照组高(P < 0.05)。2组术后3 d、7 d的PT、APTT水平均较术前提高, FIB、PAI-1、TNF-α、IL-6、hs-CRP水平均较术前降低(P < 0.05), 且观察组优于对照组(P < 0.01)。2组术后7 d的LVEF、CI水平均较术前提高, LVEDD、LVESD水平均较术前降低(P < 0.05), 且观察组优于对照组(P < 0.01)。观察组不良反应发生率与对照组比较差异无统计学意义(P>0.05);观察组术后3个月MACE发生率低于对照组(P < 0.05)。
结论替罗非班联合法舒地尔治疗可改善AMI病人PCI手术整体治疗效果, 降低MACE发生风险, 且安全性具有保证。

Abstract:
ObjectiveTo investigate the effects of tirofiban combined with fasudil on the coagulation, fibrinolysis, inflammation and echocardiographic parameters in patients with acute myocardial infarction(AMI) after PCI.
MethodsA total of 206 AMI patients treated with PCI were selected, and divided into the observation group(n=103) and control group (n=103) by random number table.The control group was treated with tirofiban, and the observation group was treated with fasudil on the basis of the control group.The immediate postoperative thrombolysis in myocardial infarction(TIMI) grade, TIMI myocardial perfusion grade(TMPG), adverse reactions and major adverse cardiovascular events(MACE) after 3 months of surgery were compared between two groups.The thrombin fibrinolytic indexesincluding the thrombin time (PT), activated partial thrombin time(APTT), fibrinogen(FIB) and plasminogen activator inhibitor-1(PAI-1), inflammatory indexesincluding the tumor necrosis factor-α(TNF-α), interleukin-6(IL-6) and hypersensitive C-reactive protein(HS-CRP) were compared between two groups before operation, and after 3 d and 7 d of operation.The echocardiographic parametersincluding the left ventricular ejection fraction(LVEF), cardiac index(CI), left ventricular end diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD) were compared between two groups before surgery and after 7 d of surgery.
ResultsThe immediate postoperative TIMI classification rate of grade 3 and rate of TMPG grade 3 in observation group were higher than those in control group(P < 0.05).After 3 d and 7 d of operation, the levels of PT and APTT increased, while the levels of FIB, PAI-1, TNF-α, IL-6 and hs-CRP decreased in two groups compared with before operation(P < 0.05), and which in observation group was better than that in control group(P < 0.01).After 7 d of operation, the levels of LVEF and CI in two groups increased, the levels of LVEDD and LVESD decreased compared with before operation(P < 0.05), and which in observation group were better than that in control group(P < 0.01).There was no statistical significance in the incidence of adverse reactions between two groups(P>0.05).The incidence of MACE in observation group was lower than that in control group after 3 months of operation(P < 0.05).
ConclusionsTirofiban combined with fasudil can improve the overall therapeutic effects of PCI, reduce the risk of MACE in AMI patients, and the safety is guaranteed.

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