目的 探討?zhàn)B心氏片聯(lián)合鹽酸替羅非班氯化鈉注射液治療急性心肌梗死的臨床療效。方法 選取2019年3月-2020年12月海南西部中心醫(yī)院收治的97例急性心肌梗死患者，按照隨機(jī)數(shù)字表法分為對(duì)照組（48例）和治療組（49例）。對(duì)照組靜脈滴注鹽酸替羅非班氯化鈉注射液，0.4 μg/（kg·min）靜脈輸注30 min，繼以0.1 μg/（kg·min）持續(xù)靜脈滴注72 h。治療組在對(duì)照組的基礎(chǔ)上口服養(yǎng)心氏片，3片/次，3次/d。兩組均治療7 d。觀察兩組的臨床療效，比較兩組的心肌梗死面積、心肌酶譜指標(biāo)、血液流變學(xué)指標(biāo)、氧化應(yīng)激指標(biāo)和心血管不良事件（MACE）。結(jié)果 治療后，治療組的總有效率93.88%高于對(duì)照組的總有效率72.92%（P<0.05）。治療后，兩組左心室舒張末期內(nèi)徑（LVEDD）、左心室收縮末期內(nèi)徑（LVESD）下降，左心室射血分?jǐn)?shù)（LVEF）升高（P<0.05），且治療組LVEDD、LVESD低于對(duì)照組，LVEF高于對(duì)照組（P<0.05）。治療后，兩組心肌梗死面積縮小，肌酸激酶（CK）、肌鈣蛋白I （cTnI）、肌酸激酶同工酶（CK-MB）水平下降（P<0.05），且治療組心肌梗死面積小于對(duì)照組，CK、cTnI、CK-MB水平均低于對(duì)照組（P<0.05）。治療后，兩組全血低切黏度、全血高切黏度、血漿黏度、纖維蛋白原均下降（P<0.05），且治療組患者全血低切黏度、全血高切黏度、血漿黏度、纖維蛋白原低于對(duì)照組（P<0.05）。治療后，兩組丙二醛（MDA）水平下降，超氧化物歧化酶（SOD）、還原型谷胱甘肽（GSH）水平升高（P<0.05），且治療組MDA水平低于對(duì)照組，SOD、GSH水平高于對(duì)照組（P<0.05）。治療后，治療組患者的MACE發(fā)生率低于對(duì)照組（P<0.05）。結(jié)論 養(yǎng)心氏片聯(lián)合鹽酸替羅非班氯化鈉注射液治療急性心肌梗死可縮小心肌梗死面積，改善心肌酶譜指標(biāo)和血液流變學(xué)指標(biāo)，減輕機(jī)體氧化應(yīng)激。

Objective To explore the clinical efficacy of Yangxinshi Tablets combined with Tirofiban Hydrochloride and Sodium Chloride Injection in treatment of acute myocardial infarction. Methods Patients (97 cases) with acute myocardial infarction in Hainan West Central Hospital from March 2019 to December 2020 were divided into the control group (48 cases) and the treatment group (49 cases) according to the random number table method. Patients in the control group were iv administered with Tirofiban Hydrochloride and Sodium Chloride Injection 0.4 μg/(kg·min), intravenous infusion for 30 min, then the intravenous infusion was continued at 0.1 μg/(kg·min) for 72 h. Patients in the treatment group were po administered with Yangxinshi Tablets on the basis of the control group, 3 tablets/time, three times daily. Patients in two groups were treated for 7 d. After treatment, the clinical efficacies were evaluated, and myocardial infarction area, myocardial zymogram indicators, hemorheology indicators, oxidative stress indicators, and cardiovascular adverse events in two groups were compared. Results After treatment, the total effective rate of 93.88% in the treatment group was higher than 72.92% in the control group (P < 0.05). After treatment, LVEDD and LVESD in two groups were decreased, but LVEF in two groups were increased (P< 0.05). LVEDD and LVESD in the treatment group were lower than those in the control group, while LVEF in the treatment group was higher than those in the control group (P< 0.05). After treatment, the myocardial infarction area of two groups were decreased, and the levels of CK, cTnI, and CK-MB of two groups were decreased (P< 0.05). The myocardial infarction area of the treatment group was smaller than that of the control group, and the levels of CK, cTnI, and CK-MB of the treatment group were lower than those of the control group (P < 0.05). After treatment, the whole blood low shear viscosity, whole blood high shear viscosity, plasma viscosity, and fibrinogen levels in two groups decreased (P < 0.05), and the whole blood low shear viscosity, whole blood high shear viscosity, plasma viscosity, and fibrinogen levels in the treatment group were lower than those in the control group (P < 0.05). After treatment, the levels of MDA in two groups were decreased, while the levels of SOD and GSH in two groups were increased (P < 0.05). The levels of MDA in the treatment group were lower than those in the control group, while the levels of SOD and GSH in the treatment group were higher than those in the control group (P < 0.05). After treatment, the incidence of MACE in the treatment group was lower than that in the control group (P< 0.05). Conclusion Yangxinshi Tablets combined with Tirofiban Hydrochloride and Sodium Chloride Injection can reduce the size of myocardial infarction of patients with acute myocardial infarction, improve myocardial enzymogram indicators and hemorheology indicators, reduce oxidative stress of the body.

R972

海南省自然科學(xué)基金資助項(xiàng)目（820MS154）