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目的探讨老年急性心肌梗死(acute myocardial infarction,AMI)患者在经皮冠状动脉介入术围术期预先应用替罗非班的临床效果。方法经右侧桡动脉径路行经皮冠状动脉介入术的AMI老年患者90例随机分为观察组和对照组各45例,观察组于术前30min、对照组于术后30min给予盐酸替罗非班氯化钠注射液10μg/kg,3min内静脉注射完毕后,继以0.15μg/(kg·min)微量泵维持24h。比较2组手术前、后TIMI血流情况、血小板相关补体1(platelet associated complement 1,PAC1)及P选择素(cluster of differentiation 62platelet,CD62P)阳性表达率、脂联素水平,测定左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)、短轴收缩率(fractional shortening,FS)和左室射血分数(left ventricular ejection fraction,LVEF),并随访1个月观察不良心脏事件发生情况。结果观察组术后3个月梗死相关血管TIMI 3级血流获得率(95.6%)高于对照组(82.2%)(P<0.05);2组术后1dPAC1、CD62P阳性表达率和脂联素水平及术后7dLVESD、FS和LVEF与治疗前比较差异均有统计学意义(P<0.05);2组术后1dPAC1、CD62阳性表达率、脂连素水平比较差异有统计学意义(P<0.01),术后7dLVESD、FS和LVEF及术后1个月不良心脏事件发生率比较差异无统计学意义(P>0.05)。结论老年AMI患者经皮冠状动脉介入围术期预先应用替罗非班,可提高治疗成功率。
Objective To investigate the clinical effect of pretreatment with tirofiban during the percutaneous coronary intervention in elderly patients with acute myocardial infarction (AMI). Methods Ninety elderly patients with AMI undergoing percutaneous coronary intervention via the right radial artery were randomly divided into observation group (45 cases) and control group (45 cases). The observation group was given 30 minutes preoperatively and the control group was given tirofiban hydrochloride Sodium chloride injection 10μg / kg, 3min after intravenous injection, followed by 0.15μg / (kg · min) trace pump 24h. The TIMI blood flow, the expression of platelet associated complement 1 (PAC1) and cluster of differentiation 62 platelet (CD62P) positive rate and adiponectin level before and after surgery were compared between the two groups. The left ventricular end-systolic Left ventricular end-systolic diameter (LVESD), fractional shortening (FS) and left ventricular ejection fraction (LVEF) were observed. The incidence of adverse cardiac events was observed at 1 month follow-up. Results The TIMP grade 3 blood flow rate (95.6%) in the infarct-related blood vessels in the observation group was significantly higher than that in the control group (82.2%) at 3 months postoperatively (P0.05) .PAC1 and CD62P positive rate in the observation group and the adiponectin (P <0.05). The positive expression rate of PAC1 and CD62 and the level of adiponectin on the 1st postoperative day in the two groups were significantly different (P <0.01), and the levels of VE, FS and LVEF on the 7th postoperative day were statistically different ). There was no significant difference in the incidence of VESD, FS, LVEF and the incidence of adverse cardiac events at 7 days after operation (P> 0.05). Conclusion The application of tirofiban before percutaneous coronary intervention in elderly patients with AMI can improve the success rate of treatment.