目的 探讨替罗非班不同给药方式对冠状动脉粥样硬化性心脏病（冠心病）患者经皮冠状动脉介入治疗（PCI）术后心肌损伤及血管内功能的影响。方法 将124例行PCI的冠心病患者随机分为观察组和对照组（每组各62例），对照组于PCI术前行替罗非班静脉给药，观察组行替罗非班冠状动脉（冠脉）给药。比较两组患者治疗后24 h的心肌损伤和血管内皮功能相关指标，以及PCI术后3个月时心功能指标及不良心血管事件的发生情况。结果 PCI术后24 h时，两组患者的血清肌酸激酶同工酶（CKMB）和心肌肌钙蛋白T（cTnT）水平均有所升高，且观察组指标水平低于对照组，差异有统计学意义（P＜0.05）。PCI术后24 h时，两组患者血清一氧化氮（NO）水平有明显减低，内皮素-1（ET-1）水平有明显升高，且观察组指标变化程度低于对照组，差异均有统计学意义（P＜0.05）。PCI术后3个月，两组患者左室舒张末内径（LVEDD）和左室收缩末内径（LVESD）均有所降低，左室射血分数（LVEF）有所提高，且观察组指标改善程度优于对照组，差异均有统计学意义（P＜0.05）。观察组PCI术后3个月内不良心血管事件发生率（4例，6.45%）低于对照组（12例，19.35%）（P＜0.05）。结论 替罗非班冠脉给药可减轻冠心病患者PCI术后短期内心肌损伤和血管内皮功能异常，对心功能的改善具有重要作用，有效避免术后各种不良心血管事件的发生。

Objective To explore the effects of different administration methods of tirofiban on myocardial injury and vascular endothelial function in patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods One hundred twenty-four patients with coronary heart disease were randomly divided into an observation group (62 cases) and a control group (62 cases). The two groups were treated with PCI. Patients in the control group were given intravenous tirofiban before PCI, and patients in the observation group were given coronary tirofiban. The indexes of myocardial injury and vascular endothelial function were compared at 24 h after PCI, and the indexes of cardiac function and the occurrence of adverse cardiovascular events were compared three months after PCI. Results At 24 h after PCI, serum levels of creatine kinase isoenzyme (CK-MB) and cardiac troponin T (cTnT) were increased in both groups, and the levels of the indicators in the observation group were lower than those in the control group, with significant differences (P<0.05; At 24 h after PCI, the serum nitric oxide (NO) level was significantly decreased, the endothelin-1 (ET-1) level was significantly increased in the two groups, and the changes of the indicators in the observation group were lower than those in the control group, with significant differences (P<0.05); At 3 months after PCI, the left ventricular end diastolic diameter (LVEDd) and left ventricular end systolic diameter (LVESD) were reduced, the left ventricular ejection fraction (LVEF) was improved in both groups, and the improvement of indicators in the observation group was better than that in the control group, with significant differences (P<0.05); The incidence of adverse cardiovascular events within 3 months after PCI in the observation group (4 patients, 6.45%) was lower than that in the control group (12 patients, 19.35%) (P<0.05). Conclusions Intracoronary administration of tirofiban could reduce myocardial injury and vascular endothelial function in patients with coronary heart disease in the short term after PCI, promote the improvement of heart function, and effectively avoid various adverse cardiovascular events.

河南省科技发展计划项目(162102310516)