瑞替普酶联合替罗非班对老年急性心肌梗死患者微循环和凝血功能的影响

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摘要目的观察瑞替普酶联合替罗非班对老年急性心肌梗死患者微循环和凝血功能的影响。方法回顾性分析2014年3月～2016年3月就诊于宝鸡市中医医院的急性心肌梗死患者120例的资料，按治疗方法的不同分为对照组和观察组，各60例。对照组给予瑞替普酶静脉滴注，观察组则给予瑞替普酶联合替罗非班静脉滴注。观察两组患者治疗前和治疗后4、24 h微循环各项相关指标、凝血功能，比较两组治疗前和治疗后4 h纤溶相关指标。结果与治疗前比较，两组急性心肌梗死患者治疗后4、24 h声学峰值强度（PI）显著增强，曲线下面积（AUC）逐渐增大，QTd间期明显缩短，差异有统计学意义（P ＜ 0.05）。治疗后4、24 h，观察组PI、AUC明显高于对照组，QTd间期明显短于对照组，差异有统计学意义（P ＜ 0.05）。同时观察组治疗后4、24 h ST段下降幅度均大于对照组，到达酶峰的时间短于对照组，差异均有统计学意义（P ＜ 0.05）。与治疗前比较，治疗后4、24 h两组心肌梗死患者凝血酶时间（TT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）明显延长，血清纤维蛋白原（FIB）含量明显降低，D-二聚体（D-D）含量明显升高，差异均有统计学意义（P ＜ 0.05）。治疗后4、24 h，观察组TT、PT、APTT均长于对照组，血清FIB含量显著低于对照组，D-D含量高于对照组，差异有统计学意义（P ＜ 0.05）。治疗4、24 h后，两组心肌梗死患者组织型纤溶酶原激活物（t-PA）活性水平升高，纤溶酶原（PLG）、α2-纤溶酶抑制物（α2-PI）和溶酶原激活物抑制剂（PAI-1）活性水平明显降低，且观察组t-PA活性水平高于对照组，PLG、α2-PI、PAI-1活性水平均低于对照组，差异有统计学意义（P ＜ 0.05）。结论瑞替普酶联合替罗非班能有效改善老年急性心肌梗死患者冠脉微循环状态和凝血功能，有利于改善缺血心肌的血流供应状态，减少心肌损伤，值得临床推广应用。

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	徐楷1 赵存瑞2 陈入菲1 孙牧1 贾军正1 刘佳1 邢尔克1▲

关键词 ：瑞替普酶, 替罗非班, 老年, 急性心肌梗死, 微循环, 凝血功能

Abstract：Objective To observe the effect of Reteplase combined with Tirofiban for the microcirculation and coagulation function of elderly patients with acute myocardial infarction. Methods The data of total 120 patients with acute myocardial infarction treated in Baoji Hospital of Traditional Chinese Medicine from March 2014 to March 2016 was analyzed retrospectively, and they were divided into control group and observation group according to different therapeutic methods, with 60 cases in each group. The control group was given Reteplase by intravenous drip, the observation group was given Reteplase combined with Tirofiban by intravenous drip. The indices of microcirculation, coagulation function before and 4, 24 h after treatment and related indices of fibrinolysis before and after treatment for 4 h between the two groups were observed and compared. Results Compared with before treatment, the peak intensity (PI) of the two groups 4, 24 h after treatment was enhanced, the area under curve (AUC) was increased and the QTd was shortened, the differences were all statistically significant (P ＜ 0.05). 4, 24 h after treatment, the PI, AUC of observation group were higher than those of control group, the QTd was shorter than that of control group, the differences were all statistically significant (P ＜ 0.05). At the same time, the falling range of ST-elevation in the observation group 4, 24 h after treatment was higher than that of control group, the time to get to the enzyme peak was faster than that of control group, the differences were all statistically significant (P ＜ 0.05). Compared with before treatment, the thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT) of the two groups 4, 24 h after treatment were prolonged, the contents of serum fibrinogen (FIB) in the two groups were decreased, while the contents of D-Dimer (D-D) were increased, the differences were all statistically significant (P ＜ 0.05). 4, 24 h after treatment, the TT, PT, APTT of observation group were longer than those of control group, the content of serum FIB was lower than that of control group, the content of D-D was higher than that of control group, the differences were all statistically significant (P ＜ 0.05). 4, 24 h after treatment, the levels of tissue plasminogen activator (t-PA) of the two groups were increased, while the levels of plasminogen (PLG), α2-plasmin inhibitor (α2-PI) and plasminogen activator inhibitor (PAI-1) were decreased, and the level of t-PA in observation group was higher than that of control group, the levels of PLG, α2-PI and PAI-1 were lower than those of control group, the differences were all statistically significant (P ＜ 0.05). Conclusion Reteplase combined with Tirofiban can effectively improve the coronary microcirculation and coagulation function of elderly patients with acute myocardial infarction, which is useful to improve the blood supply of ischemic myocardium, reduce myocardial damage, it is worthy of clinical promotion and application.

Key words： Reteplase Tirofiban Elderly Acute myocardial infarction Microcirculation Coagulation function

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引用本文:

徐楷1 赵存瑞2 陈入菲1 孙牧1 贾军正1 刘佳1 邢尔克1▲. 瑞替普酶联合替罗非班对老年急性心肌梗死患者微循环和凝血功能的影响[J]. 中国医药导报, 2017, 14(35): 130-134.
XU Kai1 ZHAO Cunrui2 CHEN Rufei1 SUN Mu1 JIA Junzheng1 LIU Jia1 XING Erke1▲. Effect of Reteplase combined with Tirofiban for the microcirculation and coagulation function of elderly patients with acute myocardial infarction. 中国医药导报, 2017, 14(35): 130-134.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2017/V14/I35/130

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