摘要
目的探讨替格瑞洛在急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入（PCI）术前应用的临床疗效。方法对急救中心确诊为急性STEMI的80例患者随机分为治疗组和对照组，每组40例。两组均接受急诊PCI术，治疗组于入院前即口服负荷量替格瑞洛，对照组口服负荷量氯吡格雷。主要观察：①PCI手术前后梗死相关动脉TIMI血流；②术后相关导联抬高的ST段回落幅度；③术后1周行超声心动图检查测定左心室射血分数（LVEF）值；④住院期间出血并发症及继发的血小板减少症的发生率；⑤术后1个月的心血管主要不良事件（MACE）发生情况。结果两组患者临床基本资料比较差异未见统计学意义；治疗组术前梗死相关动脉TIMI0～1级与对照组比较差异有统计学意义（75．0％比85．0％，P〈0．05），两组PCI术前TIMI3级比较差异未见统计学意义（10．0％比7．5％，P〉0．05），两组PCI术后TIMI3级比较差异有统计学意义（90．0％比75．0％，P〈0．05）；治疗组术后2h心电图相关导联ST段完全回落幅度（STR≥70％）高于对照组（P〈0．05）；术后1周超声心动图提示对照组LVEF低于治疗组（P〈0．05）；术后治疗组轻度出血事件较对照组略有增多，但两组比较差异未见统计学意义（P〉0．05）；两组近期MACE发生率比较差异未见统计学意义（P〉0．05）。结论替格瑞洛在急性STEMI患者急诊行PCI术前早期应用能改善术后心肌再灌注，挽救濒死心肌，恢复存活心肌细胞功能，改善心功能，且未明显增加出血事件及主要心血管不良事件。
Objective To observe the clinical effect of ticagrelor （ADP receptor antagonist） in patients acute ST-segment elevation myocardial infarction（STEMI） before primary percutaneous cor- onary intervention（PCI）. Methods Eighty patients with acute STEMI diagnosed by emergency centre were treated by primary PCI, and randomly divided into ticagrelor group and control group, with 40 cases in each group. TIMI grade flow of infarct-related artery （IRA） before and after PCI was assessed. The resolution of the sum of ST-segment elevation at 2 hours after PCI was observed. The left ventricular ejec- tion fraction （LVEF） by Ultrasonic cardiogram 1 week after PCI was examined. The incidences of the bleeding complications and thrombocytopenia during hospitalization were recorded. The major adverse cardial events 1 month after PCI were followed -up. Results TIMI grade 0 - 1 flow of IRA in control group at initial angiography before PCI was significantly higher than that in ticagrelor group （85.0% vs 75.0%, P 〈 0. 05 ）. There were no significant differences in TIMI grade 3 flow before PCI between the two groups（ 17.5% vs 12. 5%, P 〉 0.05 ）. TIMI grade 3 flow in ticagrelor group was higher than that in control group after PCI （95.0% vs 90. 0%, P 〈 0. 05 ）. There were no significant difference in TIMI grade 0 - 1 flow after PCI between two groups（6.25% vs 2. 5%, P 〉0. 05）. There was more frequently complete STR in ticagrelor group than that in control group （ 80. 0% vs 65.0%, P 〈 0. 05 ）. LVEF in control group was lower than that in ticagrelor group （P 〈 0. 05 ）. Hemorrhage rate in ticagrelor group was higher, but there was no difference between the two groups（P 〉0.05）. The incidence of MACE in control group was higher than that in ticagrelor group, but there was no significant difference （P 〉 0. 05 ）. Conclusions Administration of ticagrelor before primary PCI on patients with acute STEMI can make better the myocardial reperfusion, retrieve the moribund myocardium,
出处
《中国实用医刊》
2016年第20期15-18,共4页
Chinese Journal of Practical Medicine
