对比冠状动脉内注射替奈普酶与替罗非班对急性ST段抬高型心肌梗死的有效性及安全性

doi:10.3969/j.issn.1004-583X.2024.07.003

摘要/Abstract

摘要：

目的观察对比冠状动脉内靶向应用替奈普酶和替罗非班对急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI )的有效性及安全性。方法回顾性分析2021年8月-2023年8月南京医科大学附属明基医院接受直接经皮冠状动脉介入治疗(percutaneous coronary intervention, PCI)的STEMI患者46例,根据治疗方案分为观察组(冠状动脉内注射替奈普酶)21例,对照组(冠状动脉内注射替罗非班)25例。比较两组支架个数、心肌梗死溶栓试验(thrombolysis in myocardial infarction, TIMI)血流分级、TIMI血栓分级、校正的TIMI血流帧数计数(CTFC)、手术后2 hST段回落幅度(STR)≥50%百分比、术后N-末端B型脑钠肽前体(N-terminal pro-brain natriuretic peptide, NT-proBNP)、术后72 h左室射血分数、住院期间出血事件和心血管不良事件发生率。结果有效性方面,给药后观察组TIMI血栓分级、CTFC均优于对照组(P<0.05),观察组术后左室射血分数、术后NT-proBNP均优于对照组(P<0.05),两组支架个数、TIMI血流分级、术后2 hSTR≥50%占比差异均无统计学意义(P>0.05);安全性方面,两组住院期间出血事件、心血管不良事件发生率差异均无统计学意义(P>0.05)。结论 STEMI患者,PCI联合冠状动脉内注射替奈普酶和替罗非班均安全、有效,且替奈普酶优于替罗非班。

关键词: ST段抬高型心肌梗死, 经皮冠状动脉介入治疗, 冠脉内注射, 替奈普酶, 替罗非班

Abstract:

Objective To observe and compare the efficacy and safety of intracoronary injection of teneplase and tirofiban in the treatment of acute ST-segment elevation myocardial infarction (STEMI). Methods A retrospective analysis was performed on 46 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) in the Affiliated BenQ Hospital of Nanjing Medical University from August 2021 to August 2023. According to different treatment plans, patients were divided into observation group (n=21, intracoronary injection of teneplase) and control group (n=25, intracoronary injection of tirofiban). The number of stents, thrombolysis in myocardial infarction (TIMI) blood flow grading, TIMI thrombus grading, corrected TIMI blood flow frame count (CTFC), percentage of postoperative 2-hour ST segment regression (STR)≥50%, postoperative N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction at 72 hours after PCI, bleeding events and cardiovascular adverse events during hospitalization were compared between the two groups. Results In terms of effectiveness, TIMI thrombus classification and CTFC after intracoronary administration were superior in the observation group than control group (P<0.05), and postoperative left ventricular ejection fraction (LVEF) and postoperative NT-proBNP of observation group were superior to control group (P<0.05). There were no significant differences in the number of stents, TIMI blood flow grade and percentage of postoperative 2-hour STR≥50% between the two groups (P>0.05). In terms of safety, there were no significant differences in the incidence of bleeding events and cardiovascular adverse events during hospitalization between the two groups (P>0.05). Conclusion PCI combined with intracoronary injection of teneplase and tirofiban is safe and effective on treating STEMI, and teneplase is superior to tirofiban.

Key words: ST-segment elevation myocardial infarction, percutaneous coronary intervention, intracoronary injection, teneplase, tirofiban

中图分类号:

R542.22

张磊, 李新, 郭振峰. 对比冠状动脉内注射替奈普酶与替罗非班对急性ST段抬高型心肌梗死的有效性及安全性[J]. 临床荟萃, 2024, 39(7): 598-602.

Zhang Lei, Li Xin, Guo Zhenfeng. Efficacy and safety of intracoronary injection of teneplase versus tirofiban on the treatment of acute ST-segment elevation myocardial infarction[J]. Clinical Focus, 2024, 39(7): 598-602.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.07.003

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I7/598

图/表 6

表1 两组基线资料和及介入相关情况比较

Tab.1 Baseline data and intervention-related conditions between groups

项目	对照组( $n$ =25)	观察组( $n$ =21)	$t$ /χ²值	P值
男性[例(%)]	23(92.0)	17(81.0)	1.228	0.268
年龄(岁)	57.60±12.15	60.19±12.50	0.709	0.482
发病至就诊时间(h)	1.94±1.43	2.34±1.98	0.799	0.429
高血压[例(%)]	15(60.0)	15(71.4)	0.657	0.418
糖尿病[例(%)]	6(24.0)	7(33.3)	0.49	0.484
高脂血症[例(%)]	17(68.0)	12(57.1)	0.577	0.447
吸烟史[例(%)]	18(72.0)	14(66.7)	0.153	0.695
血肌酐(μmol/L)	85±20.85	82.71±22.80	0.355	0.724
血小板(×109/L)	252.88±75.88	285.95±125.48	1.101	0.277
罪犯血管[例(%)]
LAD	15(60.0)	10(47.6)
LCX	3(12.0)	4(19.0)	0.801	0.670
RCA	7(28.0)	7(33.3)
支架个数(个)	1.12±0.53	1.33±0.48	-1.422	0.162

表1 两组基线资料和及介入相关情况比较

Tab.1 Baseline data and intervention-related conditions between groups

项目	对照组( $n$ =25)	观察组( $n$ =21)	$t$ /χ²值	P值
男性[例(%)]	23(92.0)	17(81.0)	1.228	0.268
年龄(岁)	57.60±12.15	60.19±12.50	0.709	0.482
发病至就诊时间(h)	1.94±1.43	2.34±1.98	0.799	0.429
高血压[例(%)]	15(60.0)	15(71.4)	0.657	0.418
糖尿病[例(%)]	6(24.0)	7(33.3)	0.49	0.484
高脂血症[例(%)]	17(68.0)	12(57.1)	0.577	0.447
吸烟史[例(%)]	18(72.0)	14(66.7)	0.153	0.695
血肌酐(μmol/L)	85±20.85	82.71±22.80	0.355	0.724
血小板(×109/L)	252.88±75.88	285.95±125.48	1.101	0.277
罪犯血管[例(%)]
LAD	15(60.0)	10(47.6)
LCX	3(12.0)	4(19.0)	0.801	0.670
RCA	7(28.0)	7(33.3)
支架个数(个)	1.12±0.53	1.33±0.48	-1.422	0.162

表2 两组冠脉内给药后TIMI血流分级[例(%)]

Tab.2 TIMI blood flow grading after intracoronary administration in two groups

组别	例数	0~1级	2级	3级
对照组	25	0	2(8.0)	23(92.0)
观察组	21	0	1(4.8)	20(95.2)
$Z$ 值			0.196
P值			>0.05

表2 两组冠脉内给药后TIMI血流分级[例(%)]

Tab.2 TIMI blood flow grading after intracoronary administration in two groups

组别	例数	0~1级	2级	3级
对照组	25	0	2(8.0)	23(92.0)
观察组	21	0	1(4.8)	20(95.2)
$Z$ 值			0.196
P值			>0.05

表3 两组冠脉内给药后血栓缩小情况比较[例(%)]

Tab.3 Thrombus reduction after intracoronary administration between groups

组别	例数	无缩小(无效)	缩小(有效)
对照组	25	22(88.0)	3(22.0)
观察组	21	13(61.9)	8(38.1)
χ²值		4.271
P值		<0.05

表4 两组冠脉内给药前后CTFC比较

Tab.4 CTFC between groups before and after intracoronary administration

组别	例数	给药前	给药后
对照组	25	29.92±4.57	28.57±4.66^*
观察组	21	28.41±2.96	24.18±3.09^*
$t$ 值		1.047	12.747
P值		>0.05	<0.05

表4 两组冠脉内给药前后CTFC比较

Tab.4 CTFC between groups before and after intracoronary administration

组别	例数	给药前	给药后
对照组	25	29.92±4.57	28.57±4.66^*
观察组	21	28.41±2.96	24.18±3.09^*
$t$ 值		1.047	12.747
P值		>0.05	<0.05

表5 两组术后STR≥50%占比、NT-proBNP、LVEF比较

Tab.5 Postoperative percentage of STR ≥ 50 %, NT-proBNP and LVEF between groups

组别	例数	LVEF (%)	STR≥50% [例(%)]	NT-proBNP (pg/ml)
对照组	25	54.68±9.16	18(72.0)	1 798.85±1 383.79
观察组	21	59.81±6.75	18(85.7)	1 019.98±870.38
$t$ /χ²值		-2.125	1.262	2.32
P值		0.039	0.261	0.025

表5 两组术后STR≥50%占比、NT-proBNP、LVEF比较

Tab.5 Postoperative percentage of STR ≥ 50 %, NT-proBNP and LVEF between groups

组别	例数	LVEF (%)	STR≥50% [例(%)]	NT-proBNP (pg/ml)
对照组	25	54.68±9.16	18(72.0)	1 798.85±1 383.79
观察组	21	59.81±6.75	18(85.7)	1 019.98±870.38
$t$ /χ²值		-2.125	1.262	2.32
P值		0.039	0.261	0.025

表6 两组患者住院期间出血事件和心血管不良事件发生率比较[例(%)]

Tab.6 The incidence of bleeding events and cardiovascular adverse events during hospitalization between groups

组别	例数	出血	心衰	室性心律失常	死亡
对照组	25	1(4.0)	2(8.0)	2(8.0)	0
观察组	21	1(4.8)	1(4.8)	1(4.8)	0
χ²值		0.016	0.196	0.196	-
P值		>0.05	>0.05	>0.05	-

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