2022 年第 9 期 第 17 卷

替罗非班联合尼可地尔早期应用对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入术后再灌注损伤及心功能的影响

Effect of early application of tirofiban combined with nicorandil on reperfusion injury and cardiac function after emergency percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作者：李永慧1王小玲2郭周威1原文龙1屈艳玲1

英文作者：Li Yonghui1 Wang Xiaoling2 Guo Zhouwei1 Yuan Wenlong1 Qu Yanling1

单位：1山西省运城市中心医院心内科，运城044000；2山西省运城市中心医院健康教育科，运城044000

英文单位：1Department of Cardiology Yuncheng Central Hospital Shanxi Province Yuncheng 044000 China; 2Department of Health Education Yuncheng Central Hospital Shanxi Province Yuncheng 044000 China

关键词：ST段抬高型心肌梗死；替罗非班；尼可地尔；经皮冠状动脉介入

英文关键词：ST-segmentelevationmyocardialinfarction;Tirofiban;Nicorandil;Percutaneouscoronaryintervention

• 摘要：

• 目的 探讨替罗非班联合尼可地尔早期应用对急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入（PCI）术后再灌注损伤及心功能的影响。方法  选取山西省运城市中心医院2020年3月至2021年3月行急诊PCI的急性STEMI患者106例，按随机数字表法分为对照组（53例）和观察组（53例）。对照组术中及术后予替罗非班治疗，观察组在对照组基础上予尼可地尔治疗。比较2组PCI术后心肌梗死溶栓试验（TIMI）血流3级比例及校正的TIMI血流帧数（CTFC），手术前后心功能指标、血清炎性因子水平以及术后心血管不良事件发生情况。结果  PCI术后，观察组TIMI血流3级比例高于对照组［86.8%（46/53）比60.4%（32/53）］，CTFC低于对照组［（15±6）帧比（20±8）帧］，差异均有统计学意义（均P＜0.05）。术后1个月2组左心室舒张末期内径、左心室收缩末期容积指数均低于术前，且观察组均低于对照组，左心室射血分数、峰值射血率均高于术前，且观察组均高于对照组；血清髓过氧化物酶、C反应蛋白、白细胞介素6、B型脑钠肽水平均低于术前，且观察组均低于对照组，差异均有统计学意义（均P<0.05）。观察组心血管不良事件总发生率低于对照组，差异有统计学意义（P＜0.05）。结论 早期应用替罗非班联合尼可地尔可明显减轻急性STEMI患者急诊PCI术后心肌再灌注损伤，改善患者心功能短期预后，抑制炎症反应，减少心血管不良事件的发生率。

• Objective  To explore the effect of early application of tirofiban combined with nicorandil on reperfusion injury and cardiac function after emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods  Totally 106 patients with STEMI undergoing emergency PCI in Yuncheng Central Hospital, Shanxi Province from March 2020 to March 2021 were enrolled. Patients were randomly divided into control group (53 cases) and observation group (53 cases). The control group was treated with tirofiban during and after operation, and the observation group was treated with nicorandil based on the control group. The rate of thrombolysis in myocardial infarction (TIMI) grading 3, corrected TIMI frame count (CTFC), cardiac function indexes and serum levels of inflammatory factors before and after operation, and postoperative incidence of cardiovascular adverse events were compared between the two groups. Results  After PCI, the rate of TIMI grading 3 in the observation group was higher than that in the control group［86.8%（46/53） vs 60.4%（32/53）］, and CTFC in the observation group was lower than that in the control group［（15±6）frame vs （20±8）frame］(both P<0.05). One month after operation, left ventricular end diastolic diameter and left ventricular end systolic volume index in both groups were lower than those before operation, and the levels in the observation group were lower than those in the control group; left ventricular ejection fraction and peak ejection rate in both groups were higher than those before operation, and those in the observation group were higher than those in the control group; serum levels of myeloperoxidase, C-reactive protein, interleukin-6 and brain natriuretic peptide in both groups were lower than those before treatment, and the levels in the observation group were lower than those in the control group (all P<0.05). The total incidence of cardiovascular adverse events in the observation group was lower than that in the control group(P<0.05). Conclusions  The early application of tirofiban combined with nicorandil can significantly reduce myocardial reperfusion injury after PCI in patients with acute STEMI, improve the short-term prognosis of patients′ cardiac function, and reduce the incidence of cardiovascular adverse events.