术前负荷量替格瑞洛对急性ST段抬高型心肌梗死急诊介入治疗术中心肌灌注的影响及安全性研究

发布时间：2018-04-16 07:05

本文选题：心肌梗死 + 替格瑞洛　；参考：《中国循环杂志》2016年06期

【摘要】：目的:探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术前给予负荷量替格瑞洛对术中心肌灌注的影响及安全性。方法:将12 h内发病并接受急诊PCI的STEMI患者共105例分为替格瑞洛组(58例)和氯吡格雷组(47例)。分别于术前给予替格瑞洛180 mg或氯吡格雷600 mg嚼服。比较两组临床基线情况、PCI术中心肌梗死溶栓治疗临床试验(TIMI)血流分级、校正的TIMI帧数(CTFC)、心肌灌注分级(TMPG)、无复流/慢血流情况。结果:两组临床基线情况差异无统计学意义(P0.05)。两组患者术前TIMI血流分级差异无统计学意义(P0.05)。与氯吡格雷组相比,替格瑞洛组术中梗死相关动脉(IRA)开通后TIMI 3级血流、TMPG 3级患者比例明显增加(分别为94.8%vs 80.9%,89.7%vs 72.3%;P均0.05),CTFC明显改善[(20.0±4.9)帧vs(31.8±3.9)帧,P0.001],无复流/慢血流发生率较氯吡格雷组低(P=0.016),术后6个月出血事件较氯吡格雷组无明显增加(P0.05),主要心血管不良事件减少(P0.05)。结论:在STEMI患者急诊PCI术前给予负荷量的替格瑞洛,可减少术中无复流/慢血流的发生率,改善心肌灌注且较安全,可减少术后主要心血管不良事件发生率。
[Abstract]:Objective: to investigate the effect and safety of loading tigrilol on myocardial perfusion in patients with acute ST-segment elevation myocardial infarction (STEMI) before percutaneous coronary intervention (PCI).Methods: a total of 105 patients with STEMI who developed within 12 hours and received emergency PCI were divided into tigrilol group (n = 58) and clopidogrel group (n = 47).Patients were given tigrilol 180 mg or clopidogrel 600 mg before operation.The clinical baseline data were compared between the two groups. In the clinical trial of thrombolytic therapy for myocardial infarction during PCI, the blood flow grade, corrected TIMI frame count, and myocardial perfusion grade were compared. There was no reflow / slow flow.Results: there was no significant difference in clinical baseline between the two groups (P 0.05).There was no significant difference in TIMI blood flow grade between the two groups before operation (P 0.05).Compared with clopidogrel group,In tigrilol group, the proportion of patients with TIMI grade 3 blood flow was significantly increased after operation (94.8%vs 80.9% 89. 7 vs 72. 3%). The rate of no complex flow / slow flow was lower than that of clopidogrel group (P 0. 01 卤0. 0 卤4. 9) frame vs(31.8 卤3. 9 frame P0. 001 (P 0. 001), and the rate of no reflow / slow blood flow was lower than that of clopidogrel group (P 0. 016, P 0. 016, P < 0. 016), and that of tigrello group was significantly higher than that of clopidogrel group.There was no significant increase in bleeding events in the latter 6 months compared with that in clopidogrel group, and the main adverse cardiovascular events were decreased in the clopidogrel group (P 0.05).Conclusion: tigrilol before emergency PCI in STEMI patients can reduce the incidence of no reflow / slow flow, improve myocardial perfusion, and reduce the incidence of major adverse cardiovascular events.
【作者单位】：河南省胸科医院心内科;
【分类号】：R542.22

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