目的 觀察對于老年急性心肌梗死（AMI）患者采取急診經(jīng)皮冠狀動脈介入（PCI）治療中采用替羅非班聯(lián)合替格瑞洛和阿司匹林治療的臨床療效分析。方法 選取2016年1月-2017年12月在鄭州市第一人民醫(yī)院急診科確診為急性心肌梗死行急診PCI治療的老年患者138例，根據(jù)PCI圍術(shù)期治療藥物不同將患者分為觀察組69例和對照組69例，對照組患者術(shù)前均給予負荷量阿司匹林300 mg及替格瑞洛180 mg嚼服，觀察組在此基礎(chǔ)上加用替羅非班術(shù)前以0.4 U/（kg· min）速度靜脈泵入30 min，術(shù)后以0.1 U/（kg· min）的速度持續(xù)泵入24~36 h，術(shù)后兩組均常規(guī)口服阿司匹林和替格瑞洛，至術(shù)后12個月。對比兩組患者臨床治療效果、安全性及心肌酶標志物與超聲檢查。結(jié)果 觀察組患者無復(fù)流、慢血流、主要不良心臟事件（MACE）發(fā)生率明顯少于對照組，TIMI3及ST段回落幾率高于對照組，觀察組心肌酶標志物酸激酶同工酶（CK-MB）濃度峰值時間、左室射血分數(shù)（LVEF）及左室舒張末內(nèi)徑（LVEDd）結(jié)果明顯優(yōu)于對照組，差異均具有統(tǒng)計學(xué)意義（P<0.001）。治療后兩組血清超敏C-反應(yīng)蛋白（hs-CRP）和白介素-6（IL-6）水平均顯著降低（P<0.05）；且治療后觀察組hs-CRP、IL-6均顯著低于對照組（P<0.05）。兩組均未出現(xiàn)嚴重出血，兩組出血發(fā)生率比較差異無統(tǒng)計學(xué)意義；兩組非心源性呼吸困難發(fā)生率比較差異無統(tǒng)計學(xué)意義，入組患者均未因上述不良反應(yīng)而停用抗血小板藥物。結(jié)論 對于老年AMI患者采取急診PCI術(shù)時，應(yīng)用替羅非班聯(lián)合替格瑞洛和阿司匹林治療，可有效減少無復(fù)流或慢血流的發(fā)生幾率，改善心肌灌注功能，不增加出血風險，減少主要不良心臟事件發(fā)生。

Objective To observe the clinical efficacy of tiglilo and tirofiban in elderly patients with acute myocardial infarction (AMI) treated by emergency percutaneous coronary intervention (PCI).Methods 138 elderly patients with acute myocardial infarction diagnosed as acute myocardial infarction in emergency department of Zhengzhou First People's Hospital from January 2016 to December 2017 were selected and divided into experimental group (69 cases) and control group (69 cases) according to the different drugs used during the perioperative period of PCI.All patients were given 300 mg aspirin and 180 mg tegrilo chewing before admission,and the observation group was given replacement on this basis.Rofiban was pumped intravenously at a speed of 0.4 U/(kg·min) for 30 minutes before operation and continuously at a speed of 0.1 U/(kg·min) for 24-36 hours after operation.The patients in the two groups were followed up for 3 months.The clinical efficacy,safety,myocardial enzyme markers and ultrasonography were compared between the two groups.Results The incidence of no-reflux,slow blood flow and MACE in the experimental group was significantly less than that in the control group.The probability of TIMI3 and ST segment falling was higher than that in the control group.The peak time of CK-MB concentration and the results of LVEF and LVEDd in the experimental group were significantly better than those in the control group,with statistical significance (P<0.001).There was no significant difference in serum hs-CRP and IL-6 levels between the two groups before treatment.After treatment,the levels of hs-CRP and IL-6 in the experimental group were significantly lower than those in the control group (P<0.05).Conclusion Tiglilo combined with tirofiban can effectively reduce the incidence of no-reflow or slow blood flow,improve myocardial perfusion function,increase the risk of bleeding and reduce the occurrence of major adverse cardiac events in elderly patients with AMI undergoing emergency PCI.

鄭州市科技惠民計劃項目（172PKJHM347）