目的 探讨养心氏片联合盐酸替罗非班氯化钠注射液治疗急性心肌梗死的临床疗效。方法 选取2019年3月-2020年12月海南西部中心医院收治的97例急性心肌梗死患者，按照随机数字表法分为对照组（48例）和治疗组（49例）。对照组静脉滴注盐酸替罗非班氯化钠注射液，0.4 μg/（kg·min）静脉输注30 min，继以0.1 μg/（kg·min）持续静脉滴注72 h。治疗组在对照组的基础上口服养心氏片，3片/次，3次/d。两组均治疗7 d。观察两组的临床疗效，比较两组的心肌梗死面积、心肌酶谱指标、血液流变学指标、氧化应激指标和心血管不良事件（MACE）。结果 治疗后，治疗组的总有效率93.88%高于对照组的总有效率72.92%（P<0.05）。治疗后，两组左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）下降，左心室射血分数（LVEF）升高（P<0.05），且治疗组LVEDD、LVESD低于对照组，LVEF高于对照组（P<0.05）。治疗后，两组心肌梗死面积缩小，肌酸激酶（CK）、肌钙蛋白I （cTnI）、肌酸激酶同工酶（CK-MB）水平下降（P<0.05），且治疗组心肌梗死面积小于对照组，CK、cTnI、CK-MB水平均低于对照组（P<0.05）。治疗后，两组全血低切黏度、全血高切黏度、血浆黏度、纤维蛋白原均下降（P<0.05），且治疗组患者全血低切黏度、全血高切黏度、血浆黏度、纤维蛋白原低于对照组（P<0.05）。治疗后，两组丙二醛（MDA）水平下降，超氧化物歧化酶（SOD）、还原型谷胱甘肽（GSH）水平升高（P<0.05），且治疗组MDA水平低于对照组，SOD、GSH水平高于对照组（P<0.05）。治疗后，治疗组患者的MACE发生率低于对照组（P<0.05）。结论 养心氏片联合盐酸替罗非班氯化钠注射液治疗急性心肌梗死可缩小心肌梗死面积，改善心肌酶谱指标和血液流变学指标，减轻机体氧化应激。

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

海南省自然科学基金资助项目（820MS154）