氯吡格雷与替格瑞洛治疗急性非ST段抬高型心肌梗死的疗效及安全性比较

发布时间：2018-05-07 23:43

本文选题：替格瑞洛 + 替非罗班　；参考：《中国药房》2017年32期

【摘要】：目的:比较氯吡格雷与替格瑞洛治疗急性非ST段抬高型心肌梗死(NSTEMI)的临床疗效及安全性。方法:收集2013年10月-2015年11月我院心内科收治的NSTEMI患者160例,按随机数字表法分为观察组和对照组,各80例。两组患者均给予常规治疗,并以0.05μg/(kg·h)持续静脉泵入盐酸替非罗班氯化钠注射液等,对照组在常规治疗基础上口服负荷剂量的硫酸氯吡格雷片300 mg,之后剂量改为75 mg,qd;观察组在常规治疗的基础上口服负荷剂量的替格瑞洛片180 mg,之后改为90 mg,bid。两组患者均治疗1个月。比较两组患者治疗前后血小板集聚率、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)、纤维蛋白原水平,以及主要心血管事件(MACE)和出血事件发生率。结果:治疗前,两组患者血小板集聚率比较,差异无统计学意义(P0.05);治疗1周及1个月后,两组患者血小板集聚率显著降低,且观察组显著低于对照组,差异均有统计学意义(P0.05)。治疗1周后,两组患者LVEF、LVEDD水平比较,差异无统计学意义(P0.05);治疗1个月后,观察组患者LVEF显著升高,且显著高于对照组,对照组患者LVEDD显著降低且显著低于观察组,差异均有统计学意义(P0.05)。治疗前、治疗3 d后,两组患者纤维蛋白原水平比较,差异无统计学意义(P0.05);治疗1周、1个月后,两组患者纤维蛋白原水平均显著降低,且观察组显著低于对照组,差异均有统计学意义(P0.05)。观察组患者MACE事件发生率为11.25%,显著低于对照组的25.00%,差异有统计学意义(P0.05);两组患者出血率比较(3.75%vs.7.50%),差异无统计学意义(P0.05)。结论:与氯吡格雷比较,替格瑞洛能有效抑制NSETMI患者血小板集聚,降低纤维蛋白原水平,提高心功能,改善预后,同时并未增加出血风险,安全性较高。
[Abstract]:Objective: to compare the efficacy and safety of clopidogrel and tigrilol in the treatment of acute non-St segment elevation myocardial infarction (NSTEMI). Methods: from October 2013 to November 2015, 160 patients with NSTEMI were randomly divided into two groups: observation group (n = 80) and control group (n = 80). The patients in both groups were treated with routine therapy and were continuously injected with tefebene hydrochloride sodium chloride injection with 0. 05 渭 g/(kg / h. In the control group, the loading dose of clopidogrel sulfate was 300 mg, then the dose was 75 mg / qd, and the observation group was treated with the loading dose of tigrilol 180 mg and 90 mg / kg respectively on the basis of routine treatment. Both groups were treated for 1 month. Platelet aggregation rate, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDDN), fibrinogen level, major cardiovascular events (MACEE) and incidence of bleeding events were compared between the two groups before and after treatment. Results: before treatment, there was no significant difference in platelet aggregation rate between the two groups, but after one week and one month of treatment, the platelet aggregation rate in the two groups was significantly lower than that in the control group, and the difference was statistically significant (P 0.05). After one week of treatment, there was no significant difference in LVEF and LVEDD levels between the two groups. After one month of treatment, the LVEF of the observation group was significantly higher than that of the control group, and the LVEDD of the control group was significantly lower and significantly lower than that of the observation group. The difference was statistically significant (P 0.05). Before and 3 days after treatment, there was no significant difference in fibrinogen level between the two groups, but the fibrinogen level in the observation group was significantly lower than that in the control group after one week and one month of treatment, and the level of fibrinogen in the two groups was significantly lower than that in the control group. The difference was statistically significant (P 0.05). The incidence of MACE events in the observation group was 11.25, which was significantly lower than that in the control group (25.00), the difference was statistically significant (P 0.05), and the bleeding rate of the two groups was 3.75 vs.7.50 and there was no significant difference between the two groups (P 0.05). Conclusion: compared with clopidogrel, tigrilol can effectively inhibit platelet aggregation, decrease fibrinogen level, improve cardiac function and improve prognosis in patients with NSETMI without increasing the risk of bleeding.
【作者单位】：长沙市第一医院心血管内科;
【分类号】：R542.22

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