中国急救复苏与灾害医学杂志

目的 探究替罗非班联合依诺肝素在急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)中的应用及对冠状动脉血流与心肌灌注的影响。方法 纳入2020年1月—2023年4月成都市第三人民医院收治的106例STEMI患者，按照单双号法将所有患者分为肝素组(单号，n=53)与替罗非班组(双号，n=53)，两组均行PCI，期间肝素组给予依诺肝素治疗，替罗非班组在此基础上加用替罗非班。对比两组患者治疗前及治疗7 d后心肌梗死溶栓试验(TIMI)血流分级、心功能、心肌灌注、心肌酶谱、不良事件。结果 治疗7 d后，两组的TIMI均明显改善，且替罗非班组显著优于肝素组(Z=2.033,P<0.05)；治疗7 d后，两组患者的左心室舒张末期内径(LVEDD)、左心室收缩末期容积指数(LVESVI)均显著下降，左心室射血分数(LVEF)显著上升，且替罗非班组的LVEDD、LVESVI显著低于肝素组(t=2.843、2.434，均P<0.05),LVEF显著高于肝素组(t=2.516,P<0.05)；术后7 d，替罗非班组的ST回落率显著高于肝素组(χ²=4.711,P<0.05)，而梗死相关动脉(IRA)无复流率及矫正TIMI帧计数(cTFC)显著低于肝素组(χ²=4.867,t=2.832，均P<0.05)；治疗7 d后，两组患者的肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)水平均显著下降，且替罗非班组显著低于肝素组(t=2.735、3.351，均P<0.05)；两组出血事件发生率差异无统计学意义(P>0.05)，替罗非班组的主要不良心血管事件(MACE)发生率显著低于肝素组(χ²=4.296,P<0.05)。结论 替罗非班联合依诺肝素可治疗STEMI，恢复PCI患者术后心功能与心肌灌注，减少MACE事件，出血风险低，安全性好，值得应用

ObjectiveTo explore the application of tirofiban combined with enoxaparin during percutaneous coronary intervention (PCI) for patients with acute ST elevation myocardial infarction (STEMI) and its influence on coronary blood flow and myocardial perfusion.Methods106 patients with STEMI admitted from January 2020 to April 2023were enrolled in the Third People's Hospital of Chengdu and divided into heparin group (odd number,n=53) and tirofiban group (even number,n=53) by the odd-even number method.Both groups underwent PCI.During PCI,the heparin group was treated with enoxaparin,while the tirofiban group was added with tirofiban on the basis of the heparin group.TIMI flow grading,cardiac function,myocardial perfusion,myocardial enzymes,bleeding status and adverse event were compared between groups before treatment and after 7 days of treatment.ResultsAfter 7 days of treatment,TIMI was significantly improved in both groups,the trofene group was significantly better than the heparin group (Z=2.033,P<0.05);after 7 days of treatment,the left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic volume index (LVESVI) of the two groups decreased significantly,and the left ventricular ejection fraction (LVEF) increased significantly,and the LVEDD and LVESVI of trilofen were significantly lower than those of heparin group (t=2.843,2.434,allP<0.05),the LVEF was significantly higher than that of the heparin group (t=2.516,P<0.05);at 7 days after surgery,the ST drop rate of tolfoxine group was significantly higher than that of heparin group (χ²=4.711,P<0.05),the rate of no reflow and corrected TIMI framecount (CTFC) in the infarct-related artery (IRA) were significantly lower than those in the heparin group (χ²=4.867,t=2.832,allP<0.05);after 7 days of treatment,the levels of creatine kinase MB (CK-MB) and cardiac troponin I(c Tn I) in both groups decreased significantly,the group of tirofene was significantly lower than that of heparin (t=2.735,3.351,allP<0.05);there was no statistical significance in the difference of bleeding event incidence between the two groups (P>0.05).The incidence of major adverse cardiovascular events (MACE) was significantly lower in the tirofene group than in the heparin group (χ²=4.296,P<0.05).ConclusionThe combination of tirofiban and enoxaparin can treat STEMI,restore postoperative cardiac function and myocardial perfusion in PCI patients,reduce MACE events,have low bleeding risk,good safety,and is worthy of application