替格瑞洛对非急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后心肌微循环的影响

发布时间：2018-02-01 13:09

本文关键词： 血小板聚集抑制剂心肌梗死血管成形术经腔经皮冠状动脉　出处：《中国循环杂志》2017年04期 　论文类型：期刊论文

【摘要】：目的:探讨替格瑞洛对非急性ST段抬高型心肌梗死(NSTEMI)患者经皮冠状动脉介入治疗(PCI)后心肌微循环的影响。方法:入选2015-03至2015-12就诊的明确诊断为NSTEMI且行PCI的患者80例,随机分为替格瑞洛组(TA组,n=40)和氯吡格雷组(CA组,n=40)。所有入选患者均择期经皮冠状动脉造影检查,并行PCI。比较两组患者基线资料、PCI相关参数、术前和术后24h、72h血浆中超氧化物歧化酶(SOD)和丙二醛(MDA)水平变化。随访比较两组患者术后30天内主要不良心脏事件(MACE)的差异。结果:两组患者基线资料差异无统计学意义(P0.05)。两组患者梗死相关血管分布比例、置入支架平均长度及直径差异无统计学意义(P0.05);PCI后TA组左前降支(LAD)及右冠状动脉(RCA)校正的TIMI帧数(CTFC)均小于CA组(P0.05)。TA组左回旋支(LCX)的CTFC与CA组相比差异无统计学意义(P0.05)。两组术前心肌梗死溶栓治疗临床试验(TIMI)血流3级、术后TIMI血流3级比例及慢血流发生率差异无统计学意义(P0.05)。TA组患者肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白I(c Tn I)峰值水平均低于CA组(P0.05)。两组患者术后24h和72hMDA水平均较基线水平上升(P0.001)。术后24hTA组患者MDA水平明显低于CA组患者(P=0.023),术后72h,TA组患者MDA水平下降更明显(P=0.043)。两组患者术后24h和72hSOD水平均较基线水平下降(P0.001)。术后24hTA组患者SOD水平明显高于CA组患者(P=0.013)。术后72h,两组患者SOD水平均有所上升,TA组患者MDA水平上升更明显(P=0.049)。随访30天内,两组MACE差异无统计学意义(P0.05)。结论:替格瑞洛可改善NSTEMI患者行PCI后心肌微循环状态,且用药安全,无明显不良反应。
[Abstract]:Objective: to investigate the effect of tigrilol on percutaneous coronary intervention (PCI) in patients with non-acute ST-segment elevation myocardial infarction (NSTEMI). Effect of posterior myocardial microcirculation. Methods: 80 patients with NSTEMI and PCI were selected from 2015-03 to 2015-12. The patients were randomly divided into two groups: tigrilol group, TA group (n = 40) and clopidogrel group, CA group (n = 40). All the patients were selected for selective percutaneous coronary angiography (PTCA). The baseline data of the two groups were compared with PCI related parameters, 24 hours before and 24 hours after operation. The changes of plasma superoxide dismutase (SOD) and malondialdehyde (MDA) MDAs in plasma at 72 h were compared between the two groups within 30 days after operation. Results: there was no significant difference in baseline data between the two groups. There was no significant difference in the mean length and diameter of the implanted stent (P 0.05). The number of TIMI frames corrected by left anterior descending branch (lad) and right coronary artery (RCA) in TA group after PCI was lower than that in CA group (P 0.05). There was no significant difference between CTFC and CA group (P 0.05). The clinical trial of thrombolytic therapy for myocardial infarction before operation in the two groups was of grade 3 blood flow. There was no significant difference in the ratio of TIMI blood flow grade 3 and the incidence of slow blood flow after operation. There was no significant difference in creatine kinase isoenzyme (CK-MBB) and cardiac troponin I (cTn I) in patients in the group of P0.05 and TA. The peak level of MDA was lower than that of CA group (P 0.05), and the MDA levels at 24 h and 72 h after operation in both groups were higher than baseline level (P 0.001). The level of MDA in TA group was significantly lower than that in CA group at 24 h after operation. 72 hours after operation. The level of MDA in TA group was significantly lower than that in baseline group (P0. 001), and the levels of sod at 24 h and 72 h after operation in both groups were lower than baseline level (P 0. 001). The level of SOD in TA group was significantly higher than that in CA group at 24 h after operation. The level of SOD was increased in both groups. The level of MDA in TA group was higher than that in TA group. Conclusion: tigrilol can improve the state of myocardial microcirculation after PCI in patients with NSTEMI.
【作者单位】：河北医科大学第二医院心血管内科;
【分类号】：R542.22
【正文快照】： 急性冠状动脉综合征(ACS)是在冠状动脉(冠脉)粥样硬化的基础上,血管内斑块破裂、糜烂或溃疡,继而血小板聚集,血栓形成、血管收缩、微血管栓塞等导致急性或亚急性的心肌供氧减少的临床综合征,非急性ST段抬高型心肌梗死(NSTEMI)是其中的重要类型。开通缺血相关血管,挽救缺血心肌

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