急性冠脉综合征择期PCI患者围术期不同抗栓方案的有效性及安全性比较

发布时间：2018-03-20 01:38

本文选题：替格瑞洛　切入点：氯吡格雷　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:评价行择期经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术的急性冠脉综合征(Acute coronary syndrome,ACS)患者围手术期不同抗栓方案的有效性及安全性。方法:选择2014年12月-2016年6月在河北医科大学第二医院诊治为ACS并行择期PCI的患者280例,随机分为四组,氯吡格雷联合比伐卢定组(C1),替格瑞洛联合比伐卢定组(T1),氯吡格雷联合普通肝素组(Unfractionated heparin,UFH)(C2),替格瑞洛联合普通肝素组(T2);比较四组间30天的心血管不良事件(Major adverse cardiovascular events,MACE)及出血事件发生率并且评估影响预后的独立危险因素。结果:四组30天的MACE发生率未见明显差异(?2=2.214,P=0.529),但是生存函数曲线显示T1的生存率高于其他三组的生存率;四组间30天的严重出血事件的发生率未见明显差异(?2=2.75,P=0.432)。四组患者在轻微出血发生率有统计学意义(?2=8.400,P=0.038)。COX回归分析显示,糖尿病(OR=6.96,CI95%1.92-25.26),高血脂(OR=6.56,CI95%1.82-23.55),吸烟(OR=3.77,CI95%1.09-12.98)是发生MACE的独立危险因素。结论:术前应用替格瑞洛联合术中比伐卢定,不增加ACS择期PCI患者30天MACE事件发生率,但有升高生存率的趋势。轻微出血的风险增加,但不增加严重出血的风险。糖尿病、高脂血症、吸烟是这部分患者发生MACE事件的独立危险因素。
[Abstract]:Objective: to evaluate the efficacy and safety of different antithrombotic regimens in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI). Methods: from December 2014 to June 2016 in Hebei Province. 280 patients with ACS and selective PCI were treated in the second Hospital of Medical University. They were randomly divided into four groups. Clopidogrel combined with bivaludine, tigrilol combined with bivaludine, clopidogrel combined with common heparin, unfractionated heparin, tigrilol combined with common heparin, tigrilol combined with common heparin were compared with each other for 30 days of major adverse cardiovascular events (MACEE). The incidence of blood events and the evaluation of independent risk factors affecting prognosis. Results: there was no significant difference in the incidence of MACE in the four groups at 30 days. The survival rate of T1 was higher than that of the other three groups, but there was no significant difference in the incidence of severe bleeding events in 30 days between the four groups. The incidence of slight hemorrhage in the four groups was significantly higher than that in the control group. 2 regression analysis showed that the risk factors of MACE were 6.96% CI951.92-25.26, 6.56% CI951.82-23.55, and 3.77% CI951.09-12.98). Conclusion: the incidence of 30 days MACE events in patients with ACS PCI was not increased by using tigrilol combined with varicatine during operation. But there was a tendency to increase the survival rate. The risk of mild bleeding increased, but not the risk of severe bleeding. Diabetes, hyperlipidemia, and smoking were independent risk factors for MACE events in these patients.
【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】：R541.4

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