滕光磊,李伟,吴立荣
TENG Guanglei,LI Wei,WU Lirong

• 1:贵州医科大学内科教研室
• 2:贵州医科大学
• 3:贵州医科大学心血管内科

摘要(Abstract)：

目的:观察行急诊经皮冠状动脉介入(PCI)术前给予替格瑞洛对急性ST段抬高型心肌梗死(STEMI)患者心肌组织灌注及疗效的影响。方法:90例成功行急诊PCI治疗的STEMI患者,随机均分为观察组和对照组;行PCI术前,观察组给予负荷剂量的替格瑞洛(180 mg),对照组给予负荷剂量的氯吡格雷(600 mg);术后即刻采用心肌梗死溶栓治疗(TIMI)血流分级和术后2 h ST段回落程度(STR)评估患者术后心肌组织灌注水平,比较患者PCI术后1周和1月时的左室射血分数(LVEF)、左室舒张末径(LVEDD)、心源性死亡、再次发生心肌梗塞及再次血运重建心脏主要不良事件的发生率。结果:与术前比较,2组患者术后TIMI血流0~2级患者比例降低(P<0.05),观察组降低更明显(P<0.05);观察组术后2 h STR良好的患者比例高于对照组(P<0.05);两组患者术后1月LVEF较术后1周明显升高,LVEDD明显降低(P<0.05),但同时点两组比较,差异无统计学意义(P>0.05);术后心源性死亡、再次发生心肌梗塞及再次血运重建发生率比较,差异无统计学意义(P>0.05)。结论:STEMI患者行PCI术前给予替格瑞洛的可改善患者术后心脏功能。
Objective: To observe the influence and efficacy of Ticagrelor treatment on the perfusion of myocardial tissue before emergent percutaneous coronary intervention( PCI) on patients with acute ST elevation myocardial infarction( STEMI). Methods: 90 patients with STEMI successfully performed emergent PCI were divided randomly into two groups,observation group and control group with equal number. Observation group was given 180 mg volume of Ticagrelor; control group was given600 mg volume of Clopidogrel. Immediate application of TIMI myocardial infarction reperfusion and 2 h postoperative ST-segment resolution( > 50%) were adopted to evaluate the perfusion level of myocardial tissue after PCI. Comparing LVEF,LVEDD,the incidence rates of cardiac function and MACE at 1week and 1 month after operation. Results: Comparing with before operation condition,proportion of both groups patients with TIMI flow grades of 0 to 2 has reduced( P < 0. 05),observation group has reduced significantly( P < 0. 05); proportion of 2 h postoperative ST-segment patients was higher than that of control group( P < 0. 05). LVEF of both groups has improved significantly 1 week after operation,LVEDD has reduced significantly( P < 0. 05); meanwhile,the difference of same time points comparison of both groups showed no statistical significance( P > 0. 05). The incidence rates of cardiac function and major adverse cardiovascular events( MACE) comparison showed no statistical difference( P > 0. 05). Conclusion: The STEMI patients given Ticagrelor before PCI were proved to improve postoperative cardio function.

关键词(KeyWords)： 替格瑞洛;氯吡格雷;心肌梗塞,ST段抬高型;血管成形术,经腔,经皮冠状动脉
ticagrelor;clopidogrel;myocardial infarction,ST elevation;angioplasty,transluminal,percutaneous coronary

Abstract:

Keywords:

基金项目(Foundation): 贵州医科大学附院博士基金[gY Fybj(2016)01]

作者(Author): 滕光磊,李伟,吴立荣
TENG Guanglei,LI Wei,WU Lirong

DOI: 10.19367/j.cnki.1000-2707.2016.05.023

参考文献(References)：

• [1]杨跃进,杨进刚.第三版心肌梗死全球定义解读[J].中国循环杂志,2012(27):261-263.
• [2]Dewoo MA,Spores J,Notske R,et al.Prevalence of total coronary occlusion during the early hour of transmural myocardial infarction[J].N Engl J Med,1980(16):897-902.
• [3]Davies MJ,Thomas A.Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death[J].N Eng1 J Med,1984(18):1137-1140.
• [4]王万虹,张荣林,丁浩,等.替格瑞洛在急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗中的应用[J].中国心血管杂志,2016(1):23-26.
• [5]廖静,余辉,马依彤,等.血栓抽吸装置在急性ST段抬高型心肌梗死患者中临床疗效的Meta分析[J].中国循证心血管医学杂志,2014(2):125-130.
• [6]Kumbhani DJ,Bavry AA,Desai MY,et al.Role of aspiration and mechanical thrombectomy in patients with acute myocardial infarction undergoing primary angioplasty an updated meta-analysis of randomized trials[J].J Am Coll Cardiol,2013(16):1409-1418.
• [7]Payal K,Lars W,Eric R,et al.Reduction in first and recurrent cardiovascular events with ticagrelor compared with clopidogrel in the PLATO Study[J].Coronary Heart disease,2013(127):673-680.
• [8]王吉耀.内科学[M].2版.北京:北京人民卫生出版社,2010:301-315.
• [9]Hansson EC,Rexius H,Dellborg M,et al.Coronary artery bypass grafting-related bleeding complications in real-life acute coronary syndrome patients treated with clopidogrel or ticagrelor[J].Eur J Cardiothorac Surg,2014(4).699-705.
• [10]张冬青,田凤军.替格瑞洛治疗急性冠脉综合征的临床观察[J].中国实用内科杂志,2013(31):154-155.

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