比伐卢定联合替罗非班在高血栓负荷拟行PPCI治疗的急性ST段抬高型心肌梗死患者中的应用价值

目的:探讨替罗非班与比伐卢定联合治疗在高血栓负荷拟行直接经皮冠状动脉介入(PPCI)的急性ST段抬高型心肌梗死(STEMI)患者中的应用价值。方法:选取我院于2018年3月~2020年3月期间收治的127例高血栓负荷拟行PPCI治疗的STEMI患者。将所有患者按照入院顺序,单号分为对照组(替罗非班治疗),双号分为观察组(比伐卢定联合替罗非班治疗),分别为63例和64例。对比两组术后24 h、术后30 d支架内血栓事件、30 d内的出血事件发生率,对比两组心肌梗死溶栓试验(TIMI)血流分级变化、心功能及肌酸激酶同工酶(CKMB)峰值时间及CKMB峰值,记录两组术后不良心血管事件发生率及住院时间。结果:两组术后24 h、术后30 d均未发生支架内血栓事件,观察组30 d内的出血事件发生率较对照组低(P<0.05)。两组住院时间组间对比无明显差异(P>0.05)。两组术后1个月TIMI血流分级为Ⅲ级的占比高于术前同一分级,TIMI血流分级为0~Ⅰ级、Ⅱ级的占比低于术前同一分级(P<0.05)。观察组术后7 d左心室收缩末期内径(LVESD)、CKMB峰值小于对照组,左心室射血分数(LVEF)高于对照组,CKMB峰值时间短于对照组(P<0.05)。两组心血管不良事件总发生率对比无差异(P>0.05)。结论:比伐卢定联合替罗非班治疗高血栓负荷拟行PPCI的STEMI患者,可改善患者心功能,减少心肌损伤,改善TIMI血流分级,同时还可减少30 d内的出血事件发生率。

Application Value of Bivalirudin Combined with Tirofiban in Patients with Acute ST Segment Elevation Myocardial Infarction Undergoing PPCI with High Thrombus Load

Objective:To investigate the application value of bivalirudin combined with tirofiban in patients with acute ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI)with high thrombus load.Methods:127 patients with STEMI undergoing PPCI with high thrombus load in our hospital from March 2018 to March 2020 were selected.According to the order of admission,the single number was control group(treated with tirofiban)and the double number was observation group(treated with bivalirudin combined with tirofiban),63 cases and 64 cases respectively.The stent thrombus events at 24 h after operation and 30 d after operation,and the incidence rate of bleeding events within 30 days between the two groups were compared.The thrombolysis test for myocardial infarction(TIMI)blood flow classification,cardiac function,peak time of creatine kinase isoenzyme(CKMB)and peak value of CKMB were compared between the two groups.The incidence of postoperative adverse cardiovascular events and length of hospital stay were recorded between the two groups.Results:No stent thrombus event occurred in the two groups at 24 h after operation and 30 d after operation,and the incidence rate of bleeding events in the observation group was lower than that in the control group within 30 d(P<0.05).There was no difference in the length of hospital stay between the two groups(P>0.05).One month after operation,the proportion of TIMI blood flow gradeⅢwas higher than that of the same grade before operation,and the proportion of TIMI blood flow grade 0~Ⅰand gradeⅡwas lower than that of the same grade before operation(P<0.05).The left ventricular end systolic diameter(LVESD)and peak value of CKMB in the observation group at 7 d after operation were lower than those in the control group,the left ventricular ejection fraction(LVEF)was higher than that in the control group,and the peak time of CKMB was shorter than that in the control group(P<0.05).There was no significant difference in the total incidence rate of adverse cardiovascular events between the two groups(P>0.05).Conclusion:Bivalirudin combined with tirofiban in the treatment of patients with STEMI undergoing PPCI with high thrombotic load can effectively improve TIMI blood flow classification,improve cardiac function,reduce myocardial injury,and reduce the incidence rate of bleeding events within 30 days.