术前负荷量替格瑞洛对STEMI患者急诊介入治疗有效性及安全性研究

发布时间：2018-07-08 20:09

本文选题：替格瑞洛 + 急性ST段抬高型心肌梗死　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨急诊经皮冠状动脉介入治疗(PCI)术前负荷量替格瑞洛对急性ST段抬高型心肌梗死(STEMI)患者的有效性和安全性。方法:连续入选2015年6月1日至2016年5月30日在广西医科大学第六附属医院入住诊断为STEMI的患者,按入院次序及随机数字表分为替格瑞洛组(A组)和氯吡格雷组(B组)。PCI术前,所有患者给予负荷量阿司匹林(300 mg),此后每天100 mg维持,其中A组予负荷量替格瑞洛(180 mg),此后每次90 mg,每天2次维持,B组予负荷量氯吡格雷(300 mg),此后每次75 mg,每天1次维持。此外所有患者根据STEMI诊治指南给予常规药物治疗。记录两组患者急诊PCI术后罪犯冠状动脉心肌梗死溶栓试验(TIMI)血流情况,测定两组患者用药前、球囊扩张或血栓抽吸后、PCI术后24h及PCI术后7d血小板最大聚集率(MPA),并随访术后30d主要心血管不良事件(MACE)、出血事件和呼吸困难的发生情况。结果:1.本研究共筛选符合纳入标准STEMI的患者208例,按入院次序及随机数字表分为A组103例,B组105例。在随访期间A组有3例失访,B组有1例失访,最终入选A组100例,B组104例。两组患者的临床基础资料包括年龄、性别、高血压病、高脂血症、糖尿病、吸烟、罪犯冠状动脉、血管病变数和医院就诊至球囊扩张时间(D2B)比较差异无统计学意义(均P0.05),具有可比性。2.服药前两组患者的MPA均较高,但比较差异无统计学意义(P=0.441);球囊扩张或血栓抽吸后及PCI术后24h两组MPA均有下降,A组下降更显著,组间比较差异有统计学意义(均P0.001);PCI术后7d两组MPA仍有下降,组内与服药前相比差异有统计学意义(均P0.001),虽然组间比较差异无统计学意义(P=0.267),但A组的MPA仍较B组低。3.PCI术后A组有6例无复流(6.0%),B组有20例(19.2%),组间比较差异有统计学意义(P=0.005)。4.两组MACE的发生率各有不同,但总的MACE发生率组间比较差异无统计学意义(5.0%vs.6.7%,P=0.848)。5.两组患者30d内均未发生主要出血。A组患者有8例发生出血事件,1例次要出血,7例轻微出血,B组有4例出血事件,均为轻微出血。A组出血事件较B组多,但两组出血事件发生率比较差异无统计学意义(8.0%vs.3.9%,P=0.288)。6.A组有7例出现呼吸困难,B组有3例出现呼吸困难,两组间比较差异无统计学意义(7.0%vs.2.9%,P=0.245)。呼吸困难随着用药时间延长均可耐受,无需调整药物或停药。结论:替格瑞洛对血小板聚集抑制作用更快、更强,改善了STEMI患者急诊PCI术后无复流,且不增加主要出血风险,在需急诊介入治疗的STEMI患者中应用是安全和有效的。
[Abstract]:Objective: to evaluate the efficacy and safety of emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: the patients who were admitted to the sixth affiliated Hospital of Guangxi Medical University from June 1, 2015 to May 30, 2016 were randomly divided into two groups: tigrillo group (group A) and clopidogrel group (group B). All patients were given a dose of aspirin (100mg / d after 300 mg),). Group A received tigrilol (90mg / day after 180 mg),) and group B received clopidogrel twice a day (75mg / day after 300 mg),). In addition, all patients were given routine medication according to STEMI guidelines. The thrombolytic test (TIMI) of coronary artery infarction (TIMI) was recorded in two groups after emergency PCI. The maximal platelet aggregation rate (MPA) was observed 24 hours after PCI and 7 days after PCI after balloon dilation or thrombus aspiration. The major adverse cardiovascular events (Mace), bleeding events and dyspnea were followed up 30 days after PCI. The result is 1: 1. A total of 208 patients with STEMI were selected and divided into group A (103 cases) and group B (105 cases) according to admission order and random number table. During the follow-up period, there were 3 cases of lost visit in group A and 1 case in group B, and 104 cases in group A (100 cases) and group B (104 cases). The clinical data of the two groups included age, sex, hypertension, hyperlipidemia, diabetes, smoking, coronary artery disease, There was no significant difference in the number of vascular lesions and the time of balloon dilation (D2B) between hospital and hospital (P0.05). The MPA of the two groups before PCI was higher, but the difference was not statistically significant (P0. 441), the MPA of the two groups after balloon dilatation or thrombus aspiration and 24 hours after PCI were lower than that of the control group (P < 0. 441). There was significant difference between the two groups (P0.001). The MPA of the two groups was still decreased 7 days after PCI. Although there was no significant difference between group A and group B (P0. 267), MPA in group A was still lower than that in group B. 3. There were 6 cases without reflow in group A (6. 0%), 20 cases (19. 2%) in group B, and 20 cases (19. 2%) in group B (P0. 005). The incidence of Mace was different between the two groups, but there was no significant difference in the total Mace incidence rate between the two groups (5.0 vs. 6.7P0. 848) .5. There were 8 cases of bleeding events in group A, 1 case of secondary hemorrhage, 7 cases of minor hemorrhage, 4 cases of hemorrhage in group B, and 4 cases of hemorrhage in group A, which were more than those in group B. However, there was no significant difference in the incidence of bleeding events between the two groups (8.0vs.3.9 and 0.288) .6.There were 7 cases of dyspnea in group A and 3 cases in group B, and there was no significant difference between the two groups (7.0vs.2.9). Dyspnea can be tolerated with the prolongation of medication, no need to adjust or stop medication. Conclusion: tigrilol has a faster and stronger inhibitory effect on platelet aggregation. It can improve no reflow after emergency PCI in STEMI patients and does not increase the risk of major bleeding. It is safe and effective in STEMI patients who need emergency interventional therapy.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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