负荷剂量替格瑞洛对急性ST段抬高型心肌梗死患者急诊PCI术中冠脉无复流的影响

发布时间：2018-02-09 07:45

本文关键词： 冠心病急性ST段抬高型心肌梗死替格瑞洛经皮冠状动脉介入治疗无复流现象　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:观察急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者给予负荷剂量替格瑞洛对急诊经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术中无复流现象(No reflow phenomenon,NRP)的影响。方法:本研究入选自2015年2月至2017年2月因急性STEMI就诊于河北医科大学第二医院心内科并行急诊PCI治疗的患者共122例。入院病人依据在急诊科接受P2Y12ADP受体抑制剂的不同分为氯吡格雷组(n=69例),其中男性56例,女性13例,年龄在22-81岁(平均年龄59.61±12.59岁);替格瑞洛组(n=53例),其中男性49例,女性13例,年龄在22-82岁(平均年龄56.21±12.36岁)。氯吡格雷组患者急诊PCI术前口服氯吡格雷300mg,术后常规以75mg 1/日。替格瑞洛组患者术前嚼服替格瑞洛180mg,术后常规以90mg 2/日。术后如无禁忌给予标准剂量硝酸酯类、β受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)及他汀类等药物。观察两组基线资料及以下指标:(1)术中记录心肌梗死症状发生至血管开通时间、梗死相关动脉、术前及术后TIMI血流、心肌灌注分级(TMPG)、梗死动脉开通时校正的TIMI帧数(CTFC)、术中抽吸导管及替罗非班应用情况、支架长度、支架直径、无复流发生情况。(2)发病后每6小时测定肌酸激酶(Creatine Kinase,CK)、肌酸激酶同工酶(Creatine kinase isoenzyme,CK-MB)、肌钙蛋白I(Cardiac troponin I,c Tn I),并记录心肌酶峰值。(3)术后24小时(应用替罗非班患者在停药后8小时以上)测定血小板聚集率。术后1天完成心脏超声检查。(4)记录患者住院期间主要不良事件事件。所有数据应用SPSS 21软件进行数据处理分析,双侧P0.05定义为有统计学意义。结果:1两组患者基线资料的比较两组患者基线资料(年龄、性别、吸烟史、高血压病史、糖尿病病史、血脂异常病史、术前收缩压、舒张压、心率、Killip分级、既往心肌梗死病史、既往PCI病史、梗死部位)无统计学差异(P0.05)。两组患者术前血糖、血钾、总胆固醇、低密度脂蛋白胆固醇、肌酐、血小板计数、白细胞计数、血清BNP水平、超敏C反应蛋白(hypersensitive C reactive protein,hs CRP)无统计学差异(P0.05)。2两组患者PCI相关参数两组患者发病至梗死相关动脉开通时间、梗死相关动脉分布、支架直径、支架长度、术前及术后TIMI 3级血流例数、TMPG3级血流例数、血栓抽吸例数、替罗非班应用例数、造影剂用量差异无统计学意义(P0.05)。无复流发生比例术替格瑞洛组(9.4%vs.15.9%,P=0.29)低于氯吡格雷组,差异无统计学意义。术后替格瑞洛组血小板聚集率(28.05±15.66 vs.37.96±20.09,P=0.003)替格瑞洛组低于氯吡格雷组,差异有统计学意义(P0.05)。3两组患者心肌酶峰值的比较术后替格瑞洛组CK峰值(2512±820.4U/Lvs.2678±1428U/L,P=0.45)、CK-MB峰值(290±91.6U/Lvs.292±106.7U/L,P=0.91)、c Tn I峰值(75.26±31.81ug/ml vs.80.1±32.33ug/ml,P=0.66)低于氯吡格雷组,差异无统计学意义。4术后24小时心脏超声结果替格瑞洛组左室射血分数(55.18±7.83vs.54.83±7.30,P=0.801)高于氯吡格雷组,差异无统计学意义。替格瑞洛组左室舒张末内径(52.04±4.70mm vs.53.07±4.90mm,P=0.92)低于氯吡格雷组,差异无统计学意义。5住院期间主要不良事件替格瑞洛组出现6例轻微出血,氯吡格雷组出现3例轻微出血,差异无统计学意义(P0.05)。替格瑞洛组出现1例心力衰竭,氯吡格雷组出现2例心力衰竭,差异无统计学意义(P0.05)。替格瑞洛组出现呼吸困难比例(0.136%vs.0.016%,P=0.01)高于氯吡格雷组,差异有统计学意义。结论:替格瑞洛可以在一定程度上减少急诊PCI术中无复流发生。
[Abstract]:Objective: To observe the effect of acute ST elevation myocardial infarction (ST-segment elevation myocardial infarction, STEMI) were given a loading dose of ticagrelor in emergency percutaneous coronary intervention (Percutaneous coronary, intervention, PCI) with no reflow phenomenon (No reflow, phenomenon, NRP) effect. Methods: This study selected from February 2015 to enter in February 2017 due to acute STEMI treatment in the second hospital of Hebei Medical University Department of Cardiology underwent emergency PCI treatment in patients with a total of 122 cases of hospitalized patients. On the basis of P2Y12ADP receptor inhibitor in the emergency department is divided into clopidogrel group (n=69 cases), of which 56 were male, 13 were female, aged 22-81 years (mean age 59.61 + 12.59 years); ticagrelor group (n=53 cases), of which 49 were male, 13 were female, aged 22-82 years (mean age 56.21 + 12.36 years). Patients in clopidogrel group before emergency PCI oral clopidogrel Ray 300mg, 75mg 1/ with routine postoperative day. Ticagrelor group before chewing ticagrelor 180mg, postoperative routine with 90mg 2/. After the operation in the absence of contraindications given standard doses of nitrates, beta blockers, angiotensin converting enzyme inhibitors (ACEI) / angiotensin II receptor antagonist agent (ARB) and statin drugs. Two groups were observed at baseline and the following indicators: (1) myocardial infarction symptoms to patency time were recorded, the infarct related artery, preoperative and postoperative TIMI blood flow, myocardial perfusion grade (TMPG), the opening of the infarct artery corrected TIMI frame count (CTFC), intraoperative aspiration catheter and tirofiban application, stent length, stent diameter, the incidence of no reflow. (2) every 6 hours after the onset of the determination of creatine kinase (Creatine Kinase CK), creatine kinase isoenzyme (Creatine kinase isoenzyme, CK-MB I troponin (Cardiac), cardiac troponin I, C Tn I), And record the peak value of myocardial enzyme. (3) 24 hours after surgery (tirofiban in patients after discontinuation of 8 hours or more). The platelet aggregation rate was measured by echocardiography 1 days after operation. (4) records of patients with in-hospital major adverse event. All data using SPSS 21 software for data processing and analysis bilateral, P0.05 is defined as statistically significant. Results: compared two groups of patients with baseline data of 1 patients in the two groups at baseline data (age, gender, smoking history, hypertension, diabetes, dyslipidemia history, preoperative systolic blood pressure, diastolic blood pressure, heart rate, Killip grade, previous history of myocardial infarction, previous history of PCI. Infarct) there was no significant difference in total cholesterol (P0.05). Two groups of patients with preoperative blood glucose, serum potassium, low density lipoprotein cholesterol, creatinine, blood platelet count, white blood cell count, serum level of BNP, high sensitive C reactive protein (hypersensitive C reactive protein, HS CRP) had no statistical difference (P0.05).2 related artery in two groups of patients with PCI related parameters of two groups of patients with infarction onset to the opening time, the distribution of the infarct related artery stent diameter, stent length, preoperative and postoperative TIMI flow grade 3 cases, TMPG3 grade and number of cases, the number of cases of thrombus aspiration, tirofiban class application cases, there was no significant difference in the amount of contrast agent (P0.05). The incidence of no reflow ratio operation for Grillo group (9.4%vs.15.9%, P=0.29) than the clopidogrel group, the difference was not statistically significant. Postoperative ticagrelor group platelet aggregation rate (28.05 + 15.66 + 20.09 vs.37.96, P=0.003) ticagrelor group was lower than that of clopidogrel group, the difference was statistically significant (P0.05) compared with.3 two groups of myocardial enzymes in patients after peak ticagrelor group CK peak (2512 + 820.4U/Lvs.2678 + 1428U/L, P=0.45), the peak value of CK-MB (290 + 91.6U/Lvs.292 + 106.7U/L, P=0.91), C (75.26 + 31.81ug/ Tn I peak Ml vs.80.1 + 32.33ug/ml, P=0.66) than the clopidogrel group, there was no significant difference in 24 hours after.4 echocardiographic findings ticagrelor group left ventricular ejection fraction (55.18 + 7.83vs.54.83 + 7.30, P=0.801) was higher than that of clopidogrel group, the difference was not statistically significant. Ticagrelor group left ventricular end diastolic diameter (52.04 + 4.70mm vs.53.07 + 4.90mm, P=0.92) than the clopidogrel group, there was no statistically significant difference in in-hospital major adverse events.5 ticagrelor group had 6 cases of minor bleeding, clopidogrel group had 3 cases of minor bleeding, the difference was not statistically significant (P0.05). Ticagrelor group had 1 cases of heart failure, 2 cases of heart failure occurred clopidogrel group, no significant difference meaning (P0.05). Ticagrelor group appeared dyspnea ratio (0.136%vs.0.016%, P=0.01) is higher than that of clopidogrel group, the difference was statistically significant. Conclusion: for Grillo to a certain extent Reduction of no reflow during emergency PCI operation.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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