替格瑞洛联合替罗非班在急性冠脉综合征患者PCI术中的应用价值  

Application value of Ticagrelor combined with Tirofiban in percutaneous coronary intervention in patients with acute coronary syndrome

作　　者：孙雪梅[1] 张春来[1] 吕烨辉[1] 王海荣[1] 王霜秋 Xue-mei Sun;Chun-lai Zhang;Ye-hui Lü;Hai-rong Wang;Shuang-qiu Wang(The Fourth Department of Cardiology,Tangshan Gongren Hospital,Tangshan,Hebei 063000,China)

机构地区：[1]河北省唐山工人医院心内四科,河北唐山063000

出　　处：《中国现代医学杂志》2018年第19期117-122,共6页China Journal of Modern Medicine

摘　　要：目的观察替格瑞洛联合替罗非班在急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)中的应用效果。方法 166例行PCI术治疗的ACS患者随机分为观察组85例和对照组81例,再依据发病类型的不同将两组分别进一步分为2个亚组:观察组中的急性心肌梗死(SMI)患者50例设为观察组A,观察组中的不稳定型心绞痛(UAP)患者35例设为观察组B;对照组中的SMI病例47例设为对照组A;对照组中的UAP病例34例设为对照组B。对照组应用替罗非班,观察组在对照组的基础上给予替格瑞洛。观察各组术前及术后8 d心肌微循环指标(AT、APT、PI、A、β及A×β)和氧化应激指标(SOD、MDA、MPO及LPO)的差异。结果 (1)术后第8天各组心肌微循环指标的比较差异有统计学意义(P<0.05),各指标均较同组术前下降(P<0.05),且观察组A、观察组B的下降幅度分别低于对照组A、对照组B。(2)术后第8天各组氧化应激指标的比较差异有统计学意义(P<0.05),SOD较同组术前上升而MDA、MPO、LPO较同组术前下降(P<0.05),且观察组A、观察组B的变化幅度分别低于对照组A、对照组B。(3)术前观察组A与对照组A、观察组B与对照组B的血清炎症因子hs-CRP、TNF-α、IL-6及Hcy水平比较差异无统计学意义(P>0.05),术后第8天各组血清炎症因子hs-CRP、TNF-α、IL-6及Hcy水平比较差异有统计学意义(P<0.05),均较本组术前下降(P<0.05),且观察组A、观察组B的变化幅度分别低于对照组A、对照组B。结论替格瑞洛能改善ACS患者PCI术后心肌微循环,对氧化应激反应和炎症反应也有抑制。Objective To observe the application value of Ticagrelor combined with Tirofiban in percutaneous coronary intervention(PCI)in the patients with acute coronary syndrome(ACS).Methods Totally 166 ACS patients were randomly divided into an intervention group(85 cases)and a control group(81 cases),and each group was further divided into two subgroups according to the type of attack[i.e.acute myocardial infarction(AMI)and unstable angina pectoris(UAP)],in details:50 AMI patients of the observation group was as the observation group A and 35 UAP cases of the observation group as the observation group B;47 AMI patients of the control group was as the control group A and 34 UAP cases of the control group as the control group B.The control group was given Tirofiban,and the observation group was given Ticagrelor based on the control group.The differences of myocardial microcirculation indexes(AT,APT,PI,A,βand A×β),oxidative stress indexes(SOD,MDA,MPO and LPO)and inflammatory factors(hs-CRP,TNF-α,IL-6 and Hcy)among the groups were observed before operation and on the 8th postoperative day.Results On the 8th postoperative day,all the myocardial microcirculation indexes in each group decreased compared to the preoperative ones(P<0.05),and the decreases in the observation group A and the observation group B were significantly smaller than those in the control group A and the control group B respectively(P<0.05).On the 8th postoperative day,the SOD of each group increased and MDA,MPO and LPO decreased compared to the preoperative values(P<0.05),and the changes of the observation group A and the observation group B were smaller than those of the control group A and the control group B respectively with significant differences(P<0.05).Before operation,there was no significant difference in the level of hs-CRP,TNF-α,IL-6 or Hcy between the observation group A and the control group A and between the observation group B and the control group B(P>0.05).On the 8th postoperative day,hs-CRP,TNF-α,IL-6 and Hcy of each group were dec

关 键 词：急性冠脉综合征 经皮冠状动脉介入术 替格瑞洛 氯吡格雷 心肌微循环 氧化应激 

分 类 号：R541.4[医药卫生—心血管疾病]