替格瑞洛和氯吡格雷用于急性心肌梗塞PCI的疗效比较  

Clinical effect of ticagrelor versus clopidogrel in percutaneous coronary intervention for acute myocardial infarction

作　　者：刘东华[1] 王士凯[1] 印建荣[1] 朱其行 LIU Dong-hua WANG Shi-kai YIN Jian-rong ZHU Qi-xing(Pizhou People＇s Hospital, Pizhou 221300, China)

机构地区：[1]江苏省邳州市人民医院,江苏邳州221300

出　　处：《心血管病防治知识（学术版）》2017年第9期21-24,共4页Prevention and Treatment of Cardiovascular Disease

摘　　要：目的比较替格瑞洛和氯吡格雷用于急性心肌梗塞经皮冠状动脉介入治疗(PCI)的效果。方法选择2015年1月~2017年1月50例急性心肌梗塞患者,均行经皮冠状动脉介入治疗(PCI),依据随机数字表法,随机分为2组(n=25):研究组和对照组。对照组于PCI术前口服氯吡格雷负荷量600mg,术后口服氯吡格雷维持量75mg/次,1次/d;研究组于PCI术前口服替格瑞洛负荷量180mg,术后口服替格瑞洛维持量90mg/次,2次/d。两组均于PCI术前口服阿司匹林300mg,术后口服阿司匹林100mg/次,1次/d。比较两组治疗前和治疗3个月后左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)和血小板板聚集率。记录治疗后3月主要心血管不良事件(MACE)发生率、支架血栓发生率和出血风险发生率。比较治疗前后肝功能(血清谷草转氨酶-AST、血肌酐)。结果研究组LVEF高于对照组(P<0.05),LVEDD和血小板聚集率低于对照组(P<0.05)。研究组治疗3月MACE发生率低于对照组(P<0.05),支架血栓发生率和出血风险发生率比较差异无统计学意义(P>0.05)。两组AST和血肌酐比较差异无统计学意义(P>0.05)。结论替格瑞洛有效改善急性心肌梗塞PCI术患者的左心室功能,降低血小板聚集和MACE发生率,效果优于氯吡格雷,而对肝功能无明显影响。Objective To investigate the clinical effect of ticagrelor versus clopidogrel in percutaneous coronary intervention（PCI） for acute myocardial infarction. Methods A total of 50 patients with acute myocardial infarction who underwent PCI from January 2015 to January 2017 were enrolled and divided into study group and control group using a random number table, with 25 patients in each group. The patients in the control group were given oral clopidogrel at a loading dose of 600 mg before PCI and a maintenance dose of 75 mg/time once a day after PCI, and those in the study group were given oral ticagrelor at a loading dose of 180 mg before PCI and a maintenance dose of 90 mg/time twice a day after PCI. All patients were given oral aspirin 300 mg before PCI and 100 mg/time once a day after PCI. The two groups were compared in terms of left ventricular ejection fraction（LVEF）, left ventricular end diastolic diameter（LVEDD）, and platelet aggregation rate. The incidence rates of major adverse cardiovascular events（MACEs）, stent thrombosis, and bleeding risks were recorded at 3 months after treatment. Liver function parameters including serum aspartate aminotransferase（AST） and serum creatinine were compared before and after treatment. Results Compared with the control group, the study group had significantly higher LVEF and significantly lower LVEDD and platelet aggregation rate（all P〈0.05）. At 3 months after treatment, the study group had a significantly lower incidence rate of MACE than the control group（P〈0.05）, while there were no significant differences in the incidence rates of stent thrombosis and bleeding risks between the two groups（P〈0.05）. There were also no significant differences in serum AST and serum creatinine between the two groups（P〈0.05）. Conclusion In patients with acute myocardial infarction undergoing PCI, ticagrelor can effectively improve left ventricular function and reduce platelet aggregation and the incidence rate of MACE; it has a better clinical eff

关 键 词：急性心肌梗塞 PCI 替格瑞洛 氯吡格雷 疗效 

分 类 号：R542.22[医药卫生—心血管疾病]