急诊PCI治疗中应用替格瑞洛对STEMI患者微血管损伤及心功能的影响

发布时间：2018-09-01 12:17

【摘要】：目的探讨替格瑞洛在ST段抬高型心肌梗死(STEMI)患者急诊PCI治疗中对微血管损伤及心功能的影响。方法选择拟行急诊PCI治疗的STEMI患者85例,随机分为替格瑞洛组44例和氯吡格雷组41例。两组均行急诊PCI治疗,替格瑞洛组术前口服替格瑞洛180 mg,术后维持剂量90 mg/次,2次/d;氯吡格雷组术前口服氯吡格雷600 mg,术后维持剂量75 mg/次,1次/d。两组治疗时间均为12个月。两组术后即刻进行微循环阻力指数(IMR)监测,记录主动脉平均压(Pa)、远端冠状动脉平均压(Pd)以及最大充血状态下生理盐水流动的平均传导时间(Hyper Tmn)、静息状态下生理盐水流动的平均传导时间(Rest Tmn),计算血流储备分数(FFR)、冠状动脉血流储备分数(CFR)及IMR。两组术后24 h及术后3个月进行超声心动图检查,记录舒张末期容积(EDV)、收缩末期容积(ESV)、左室射血分数(LVEF)和室壁运动指数(WMSI)。结果替格瑞洛组Hyper Tmn、IMR均低于氯吡格雷组(P均0.05),两组Pa、Pd、Rest Tmn、FFR、CFR比较差异均无统计学意义(P均0.05)。两组术后3个月WMSI均低于同组术后24 h(P均0.05),两组术后3个月WMSI比较差异均无统计学意义(P均0.05)。两组术后24h及术后3个月EDV、ESV、LVEF比较差异均无统计学意义(P均0.05)。结论 STEMI患者急诊PCI治疗中应用替格瑞洛较氯吡格雷更有助于减轻微血管损伤,从而改善心功能。
[Abstract]:Objective to investigate the effect of tigrilol on microvascular injury and cardiac function in patients with ST segment elevation myocardial infarction (STEMI) treated with emergency PCI. Methods Eighty-five patients with PCI were randomly divided into two groups: tigrillo group (n = 44) and clopidogrel group (n = 41). Both groups were treated with emergency PCI. The maintenance dose of tigrilol was 90 mg/ d before operation in tigrello group, and 75 mg/ d / d in clopidogrel group before and after clopidogrel 600 mg,. Both groups were treated for 12 months. Microcirculation resistance index (IMR) was monitored immediately after operation in both groups. Mean Aortic pressure (Pd) of distal Coronary artery in (Pa), and mean conduction time of normal Saline flow under maximum congestive condition (Rest Tmn), calculation of Blood flow Reserve at rest of normal Saline flow (FFR), coronary flow reserve fraction (CFR) and IMR. Echocardiography was performed 24 hours after operation and 3 months after operation in both groups. End diastolic volume (EDV), end-systolic volume (ESV), left ventricular ejection fraction (LVEF) and wall motion index (WMSI).) were recorded. Results the Hyper Tmn,IMR of tigrilol group was lower than that of clopidogrel group (P 0. 05). There was no significant difference in Pa,Pd,Rest Tmn,FFR,CFR between the two groups (P 0. 05). The WMSI of the two groups at 3 months after operation was lower than that of the same group at 24 h (P. There was no significant difference in WMSI between the two groups at 3 months after operation (all P 0.05). There was no significant difference in EDV,ESV,LVEF between the two groups 24 hours after operation and 3 months after operation (P 0.05). Conclusion the application of tigrilol in emergency PCI treatment for STEMI patients is more helpful to alleviate microvascular injury and improve cardiac function than clopidogrel.
【作者单位】：安徽医科大学附属省立医院;马鞍山市人民医院;
【基金】：安徽省国际科技合作计划项目(0908703042)
【分类号】：R542.22

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