CAJ | 학술논문

目的：探讨盐酸替罗非班在急性 ST 段抬高型心肌梗死（ STEMI ）患者直接经皮冠状动脉介入术（ PCI）后对心功能及血浆B型利钠肽（ BNP）的影响。方法选择2011年2月-2013年1月南方医科大学南方医院行直接PCI的急性STEMI患者104例，并采用简单随机抽样法将其平均分为观察组（52例）和对照组（52例）。观察组行直接PCI联合应用盐酸替罗非班治疗，对照组行直接PCI治疗。比较两组患者术后心肌再灌注指标〔病变血管心肌梗死溶栓治疗（ TIMI ）3级血流、心肌灌注（ TMP ）3级水平、90 min 心电图 ST 段抬高总和回落百分比（ sumSTR）〕；术后1、4周的心功能指标〔左心室射血分数（ LVEF）、左心室舒张末期内径（ LVEDD）和左心室收缩末期内径（ LVESD）〕；手术前后血浆BNP水平变化；术后3个月内主要心脏不良事件发生率。结果观察组术后TMP 3级水平发生率和术后90 min心电图sumSTR＞50％发生率高于对照组（ P＜0.05）；而两组患者术后病变血管TIMI 3级血流发生率比较，差异无统计学意义（P＞0.05）。组间比较显示，观察组术后1周LVEF高于对照组（P＜0.05），两组术后4周LVEF、LVEDD、LVESD比较，差异均有统计学意义（ P＜0.05）；组内比较显示，观察组术后4周LVEF、LVEDD与术后1周比较，差异有统计学意义（ P＜0.05）；对照组术后4周LVEF、LVESD与术后1周比较，差异有统计学意义（P＜0.05）。术前和术后1、4周两组患者血浆BNP水平比较，差异均有统计学意义（P＜0.05）。组间比较显示，观察组术后1、4周血浆BNP水平低于对照组（ P＜0.05）；组内比较显示，观察组术后4周血浆BNP 水平低于术前和术后1周，术后1周血浆BNP 水平低于术前（ P＜0.05）；对照组术后1、4周血浆BNP 水平低于术前（ P＜0.05）。术后3个月内观察组主要心脏不良事件发生率低于对照组〔7.7％（4/52）与23.1％（12/52），P＜0.05〕。结论盐酸替罗非班能明显改善急性STEMI患者直接PCI后心功能，降低血浆BNP水平和主要心脏不良事件发生率，为临床应用提供参考价值。目的：探討鹽痠替囉非班在急性 ST 段抬高型心肌梗死（ STEMI ）患者直接經皮冠狀動脈介入術（ PCI）後對心功能及血漿B型利鈉肽（ BNP）的影響。方法選擇2011年2月-2013年1月南方醫科大學南方醫院行直接PCI的急性STEMI患者104例，併採用簡單隨機抽樣法將其平均分為觀察組（52例）和對照組（52例）。觀察組行直接PCI聯閤應用鹽痠替囉非班治療，對照組行直接PCI治療。比較兩組患者術後心肌再灌註指標〔病變血管心肌梗死溶栓治療（ TIMI ）3級血流、心肌灌註（ TMP ）3級水平、90 min 心電圖 ST 段抬高總和迴落百分比（ sumSTR）〕；術後1、4週的心功能指標〔左心室射血分數（ LVEF）、左心室舒張末期內徑（ LVEDD）和左心室收縮末期內徑（ LVESD）〕；手術前後血漿BNP水平變化；術後3箇月內主要心髒不良事件髮生率。結果觀察組術後TMP 3級水平髮生率和術後90 min心電圖sumSTR＞50％髮生率高于對照組（ P＜0.05）；而兩組患者術後病變血管TIMI 3級血流髮生率比較，差異無統計學意義（P＞0.05）。組間比較顯示，觀察組術後1週LVEF高于對照組（P＜0.05），兩組術後4週LVEF、LVEDD、LVESD比較，差異均有統計學意義（ P＜0.05）；組內比較顯示，觀察組術後4週LVEF、LVEDD與術後1週比較，差異有統計學意義（ P＜0.05）；對照組術後4週LVEF、LVESD與術後1週比較，差異有統計學意義（P＜0.05）。術前和術後1、4週兩組患者血漿BNP水平比較，差異均有統計學意義（P＜0.05）。組間比較顯示，觀察組術後1、4週血漿BNP水平低于對照組（ P＜0.05）；組內比較顯示，觀察組術後4週血漿BNP 水平低于術前和術後1週，術後1週血漿BNP 水平低于術前（ P＜0.05）；對照組術後1、4週血漿BNP 水平低于術前（ P＜0.05）。術後3箇月內觀察組主要心髒不良事件髮生率低于對照組〔7.7％（4/52）與23.1％（12/52），P＜0.05〕。結論鹽痠替囉非班能明顯改善急性STEMI患者直接PCI後心功能，降低血漿BNP水平和主要心髒不良事件髮生率，為臨床應用提供參攷價值。
목적：탐토염산체라비반재급성 ST 단태고형심기경사（ STEMI ）환자직접경피관상동맥개입술（ PCI）후대심공능급혈장B형리납태（ BNP）적영향。방법선택2011년2월-2013년1월남방의과대학남방의원행직접PCI적급성STEMI환자104례，병채용간단수궤추양법장기평균분위관찰조（52례）화대조조（52례）。관찰조행직접PCI연합응용염산체라비반치료，대조조행직접PCI치료。비교량조환자술후심기재관주지표〔병변혈관심기경사용전치료（ TIMI ）3급혈류、심기관주（ TMP ）3급수평、90 min 심전도 ST 단태고총화회락백분비（ sumSTR）〕；술후1、4주적심공능지표〔좌심실사혈분수（ LVEF）、좌심실서장말기내경（ LVEDD）화좌심실수축말기내경（ LVESD）〕；수술전후혈장BNP수평변화；술후3개월내주요심장불량사건발생솔。결과관찰조술후TMP 3급수평발생솔화술후90 min심전도sumSTR＞50％발생솔고우대조조（ P＜0.05）；이량조환자술후병변혈관TIMI 3급혈류발생솔비교，차이무통계학의의（P＞0.05）。조간비교현시，관찰조술후1주LVEF고우대조조（P＜0.05），량조술후4주LVEF、LVEDD、LVESD비교，차이균유통계학의의（ P＜0.05）；조내비교현시，관찰조술후4주LVEF、LVEDD여술후1주비교，차이유통계학의의（ P＜0.05）；대조조술후4주LVEF、LVESD여술후1주비교，차이유통계학의의（P＜0.05）。술전화술후1、4주량조환자혈장BNP수평비교，차이균유통계학의의（P＜0.05）。조간비교현시，관찰조술후1、4주혈장BNP수평저우대조조（ P＜0.05）；조내비교현시，관찰조술후4주혈장BNP 수평저우술전화술후1주，술후1주혈장BNP 수평저우술전（ P＜0.05）；대조조술후1、4주혈장BNP 수평저우술전（ P＜0.05）。술후3개월내관찰조주요심장불량사건발생솔저우대조조〔7.7％（4/52）여23.1％（12/52），P＜0.05〕。결론염산체라비반능명현개선급성STEMI환자직접PCI후심공능，강저혈장BNP수평화주요심장불량사건발생솔，위림상응용제공삼고개치。
Objective To evaluate the effect of tirofiban on the heart function and B-type brain natriuretic peptide ( BNP)level in patients with ST-segmentelevation myocardial infarction( STEMI)who received primary percutaneous coronary intervention(PCI). Methods From February 2011 to January 2013 one hundred and four patients of Nanfang Hospital,South-ern Medical University,with STEMI were randomly divided into observation group and control group, with 52 cases in each group. The observation group group was received tirofiban plus PCI and the control group was treated with PCI. TIMI grade 3 , TMP grade 3 of myocardial perfusion,the resolution of the sum of ST-segment elevation( sumSTR)90 minutes after the opera-tion,the serum BNP levels and heart function as well as major adverse cardiovascular events( MACE)were observed and com-pared between the two groups. Results The percentage of TMP 3 and sumSTR>50% in the observation group were significantly higher than those of the control group(P<0. 05). There was no statistically significant difference of TIMI grade 3 between the two groups(P>0. 05). The level of LVEF of the observation group was significantly higher than that of the control group 1 week after operation(P<0. 05). There were significant differences of the levels of LVEF,LVEDD and LVESD 4 weeks after opera-tion between the two groups(P<0. 05). Comparison results of within-group indicated that there were significant differences between LVEF,LVEDD 1 week after the operation and those 4 weeks after the operation in the observation group(P<0. 05). The control group after 4 weeks LVEF,LVESD compared with after 1 week,the difference was statistically significant( P <0. 05). There was significant difference in plasma BNP level between two groups before the operation,1 week and 4 weeks after the operation(P<0. 05). The BNP levels of the observation group 1 and 4 weeks after operation were significantly lower than that of the control groups(P<0. 05). Observation group after 4 weeks of plasma BNP levels below the preoperative and postop-erative 1 week,1 week after preoperative plasma BNP levels below(P<0. 05);the control group after 1,4 weeks preoperative plasma BNP levels below before(P<0. 05). The incidence of MACE was significantly lower in observation group than that in control group within 3 months postoperatively〔7. 7%(4/52)vs. 23. 1%(12/52),P<0. 05〕. Conclusion Tirofiban can improve the heart function and level of BNP and educe adverse events after operation in patients with acute STEMI who received primary PCI.