PCI术联合替罗非班对ST...影响及其预后的高危因素分析_陈琳琳.pdf

转化医学杂志 2022年12月 第11卷 第6期Translational Medicine Journal,Vo1.11 NO.6,Dec 2022PCI术联合替罗非班对STEMI患者心室跨壁复极离散度的影响及其预后的高危因素分析陈琳琳，周娟，周瑾 摘要 目的 探讨PCI术联合替罗非班对STEMI患者心室跨壁复极离散度的影响，并分析其预后的高危因素。方法选取2019年7月-2022年7月于淮安市第二人民医院确诊为ST段抬高型心肌梗死并实施PCI术的患者116例。按照随机数表法将116例患者分为对照组（n=58）和实验组(n=58)。对照组与实验组均采用经皮冠状动脉介入治疗（PCI），术中实验组冠脉内予以替罗非班，对照组不予以替罗非班。1个月后，比较观察2组患者不良事件发生率（不稳定心绞痛、恶性心律失常、心肌梗死再发生、心力衰竭、死亡）、生活质量量表（SF36）评分及T波峰末间期（Tp-Te）、Tp-Te离散度，并使用多因素 Logistic回归分析其预后高危因素。结果对照组的不良事件发生率高于实验组（P0.05）。治疗后，实验组 SF36各项评分均高于对照组，Tp-Te、Tp-Te离散度较实验组更低（P0.05）。多因素Logistic回归分析结果显示良好组的年龄65岁、心功能分级级、合并高血压、糖尿病、高脂血症、有冠心病家族史、有吸烟史、病变部位为前壁梗死型、冠脉病变2支以及未联合替罗非班为PCI手术治疗STEMI患者预后不良的独立高危因素。结论PCI术联合替罗非班能有效降低STEMI患者术后不良事件发生率，改善其生活质量和Tp-Te、Tp-Te离散度，年龄65岁、心功能分级级、合并高血压、糖尿病、高脂血症、有冠心病家族史、有吸烟史、病变部位为前壁梗死型及冠脉病变2支均为预后的独立高危因素。关键词 ST段抬高型心肌梗死；经皮冠状动脉介入治疗；替罗非班；跨壁复极离散度；危险因素 中图分类号 R542.2 文献标志码 A 文章编号 2095-3097（2022）06-0369-05doi:10.3969/j.issn.2095-3097.2022.06.009Study on combination of PCI and triofiban in treatment of STEMI patients andthe prognostic risk factorsCHEN Linlin1,ZHOU Juan1,ZHOU Jin2(1.ECG Room of Huaian Second Peoples Hospital,Huaian Jiangsu 223002,China;2 Color Ultrasound Room of Huaian Second Peoples Hospital,Huaian Jiangsu 223002,China)Abstract Objective To study the clinical effect of percutaneous coronary intervention(PCI)combined with tirofiban on transmural dispersion of repolarization in patients with ST-segment elevation myocardial infarction(STEMI),and explore the high-risk factors affecting the prognosis.MethodsOne hundred and sixteen patients with STEMI underwent PCI in our hospital from July 2019 to July 2022 were enrolled,and devided into two groups by random numbertable methods,with 58 cases in each group.Before PCI,all patients were administered a loading dose of 300mg aspirinand 180mg ticagrelor.Coronary angiography procedures were performed via radial or femoral artery.PCI combinedwith thrombus aspiration treatment were performed.Perioperative anticoagulation was achieved with intravenous heparin.Experimental group received intracoronary injection of 10 gkg(-1)tirofiban,while control group received no tirofiban injection.After surgery,all patients were administered with aspirin(100mg once a day)and clopidogrel(75mgonce a day).After 1 month of treatment,comparison was conducted on adverse events(unstable angina pectoris,malignant arrhythmia,recurrence of myocardial infarction,heart failure,and death),MOS-36-item short-from health survey(SF-36)score,T wave peaktoend interval(Tp-Te),and Tp-Te dispersion.Thereafter,risk factors affecting the prognosis in STEMI patients were screened using multivariate Logistic regression analysis model.Results The overall adverse reaction rate of the control group was higher than that of the experimental group(P0.05).After treatment,experimental group scored higher on SF-36 than control group(P0.05),and the Tp-Te interval and Tp-Te dispersion were notably decreased in the control group compared with the experimental group(P0.05).Multivariate logistic regressionanalysis showed that age 65 years,cardiac function grade III,hypertension,diabetes,hyperlipidemia,family historyof coronary heart disease,smoking history,lesion site of anterior wall infarction,coronary artery lesion 2,and no com作者单位 223002 江苏 淮安，淮安市第二人民医院心电图室（陈琳琳，周娟），彩超室（周瑾）369转化医学杂志 2022年12月 第11卷 第6期Translational Medicine Journal,Vo1.11 NO.6,Dec 2022bination of tirofiban were independent risk factors for poor prognosis of patients with STEMI treated by PCI.Conclusion PCI combined with tirofiban can effectively reduce the incidence of postoperative adverse events in STEMI patients,improve their quality of life and Tp Te,Tp Te dispersion.Age 65 years old,cardiac function grade III,hypertension,diabetes,hyperlipidemia,family history of coronary heart disease,smoking history,anterior wall infarct type lesions and coronary artery lesions 2 are independent high-risk factors for prognosis.Key words ST-segment elevation myocardial infarction;Percutaneous coronary intervention;Tirofiban;Transmural dispersion of repolarization;Risk factorsST 段抬高型心肌梗死（ST-segment elevationmyocardial infarction,STEMI）是急性心肌梗死的一种，首发症状为胸痛，心电图表现为相应导联ST段抬高,常由冠状动脉粥样硬化斑块破裂造成血小板聚集形成血栓引起1。主要治疗方法为经皮冠状动脉 介 入 治 疗（percutaneous coronary intervention,PCI）2，是一种经心导管技术疏通狭窄甚至闭塞的冠状动脉管腔，来改善心肌的血流灌注的治疗方法。替罗非班是一种抗血小板药物，常用于冠心病、心肌缺血、动脉粥样硬化等由于血液过凝导致的血管堵塞性疾病，相关研究发现，替罗非班可通过控制心肌肌钙蛋白 I水平发挥对心功能的改善作用；其在跨壁复极中的作用可能是抑制L型钙通道蛋白磷酸化及肌浆网钙转运蛋白磷酸化过程，从而影响心肌细胞钙转运，抑制复极期心肌细胞内钙离子水平，减少钠钙交换体的电流；从而发挥影响跨壁复极的作用3-4。目前临床上关于 PCI 术联合替罗非班对STEMI患者心室跨壁复极离散度(Transmural dispersion of repolarization,TDR)影响的研究较少。本研究将探讨PCI术联合替罗非班对STEMI患者心室跨壁复极离散度的影响，并分析其预后的高危因素，为STEMI患者的治疗提供参考依据。1资料与方法1.1 一般资料 本研究为前瞻性研究，选取2019年7月-2022年7月于淮安市第二人民医院确诊为ST段抬高型心肌梗死并采用PIC术的患者116例。纳入标准：符合 2015年中国急性ST段抬高型心肌梗死诊断及治疗指南 发布的 STEMI诊断标准5。采用 PCI 术治疗。意识清醒，无认知功能障碍。临床随访资料齐全。排除标准：依从性差，无法配合研究相关事宜。患有肝、肾、肺等其他重大脏器疾病。患有精神疾病。患有恶性肿瘤。有血液系统、免疫系统疾病。按照随机数表法将116例患者分为对照组（n=58）和实验组(n=58)。本研究通过伦理委员会审查（20190673），所有受试者均签署知情同意书。1.2 方法1.2.1 治疗方法 对照组与实验组均采用经皮冠状动脉介入治疗（PCI），于术前服用阿司匹林300 mg（拜 耳 医 药 保 健 有 限 公 司 生 产，国 药 准