院前抗血小板治疗对ST段抬高型心肌梗死患者血小板聚集、心功能及心血管事件的影响  

Impact of Prehospital Antiplatelet Therapy on Platelet Aggregation,Cardiac Function and Cardiovascular Events in Patients with ST-segment Elevation Myocardial INFARCTION

作　　者：韩朝[1] 高宏[2] HAN Zhao;GAO Hong(Baoji Vocational Technical Institute,Baoji 721013,China;Baoji Central Blood Station,Baoji 721000,China)

机构地区：[1]宝鸡职业技术学院,陕西宝鸡721013 [2]陕西省宝鸡市中心血站,721000

出　　处：《实用心脑肺血管病杂志》2019年第6期82-85,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：陕西省医学科学研究重点课题计划项目(2016JM2953)

摘　　要：目的 探讨院前抗血小板治疗对ST段抬高型心肌梗死(STEMI)患者血小板聚集、心功能及心血管事件的影响。方法 选取2015年8月—2018年7月宝鸡职业技术学院附属医院收治的STEMI患者123例,根据院前治疗方法分为对照组(n=63)和试验组(n=60)。对照组患者给予常规院前急救,试验组患者在对照组基础上给予院前抗血小板治疗(包括阿司匹林和氯吡格雷)。比较两组患者入院前及入院后1、7d组织型纤溶酶原激活物(t-PA)、纤溶酶原激活剂抑制物(PAI-I)、血小板最大聚集率(MPAR)及心功能指标〔包括左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF)及心输出量(CO)〕,观察两组患者治疗期间不良反应发生情况及随访6个月心血管事件发生情况。结果 (1)时间与方法在t-PA、PAI-I水平及MPAR上存在交互作用(P<0.05);时间、方法在t-PA、PAI-I水平及MPAR上主效应显著(P<0.05);试验组患者入院后1、7dt-PA水平高于对照组,PAI-I水平、MPAR低于对照组(P<0.01)。(2)时间与方法在LVEDV、LVESV、LVEF、CO上存在交互作用(P<0.05);时间、方法在LVEDV、LVESV、LVEF、CO上主效应显著(P<0.05);试验组患者入院后1、7dLVEDV、LVESV大于对照组,LVEF、CO高于对照组(P<0.05)。(3)两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。(4)试验组患者随访6个月心血管事件发生率低于对照组(P<0.05)。结论 院前抗血小板治疗可有效减少STEMI患者血小板聚集、血栓形成及近期心血管事件的发生,改善患者心功能,且未增加不良反应发生风险。Objective To investigate the impact of prehospital antiplatelet therapy on platelet aggregation, cardiac function and cardiovascular events in patients with ST-segment elevation myocardial infarction(STEMI). Methods A total of 123 patients with STEMI were selected in Affiliated Hospital of Baoji Vocational Technical Institute from August 2015 to July 2018,and they were divided into control group(n=63)and test group(n=60)according to prehospital therapy. Patients in control group received conventional first aid,while patients in test group received prehospital antiplatelet therapy (including aspirin and clopidogrel)based on that of control group. Platelet aggregation related indicators(including t-PA, PAI-I and MPAR),index of cardiac function(including LVEDV,LVESV,LVEF and CO)before admission,1 day and 7 days after admission were compared between the two groups,incidence of adverse reactions during treatment and incidence of cardiovascular events during the 6-month follow-up were observed. Results (1)There was statistically significant interaction in t-PA,PAI-I and MPAR between time and method,respectively(P<0.05);main effects of time and method were statistically significant in t-PA,PAI-I and MPAR(P<0.05);1 day and 7 days after admission,t-PA in test group was statistically significantly higher than that in control group,respectively,while PAI-I and MPAR in test group were statistically significantly lower than those in control group(P<0.05).(2)There was statistically significant interaction in LVEDV,LVESV,LVEF and CO between time and method,respectively(P<0.05);main effects of time and method were statistically significant in LVEDV,LVESV,LVEF and CO(P<0.05);1 day and 7 days after admission,LVEDV and LVESV in test group were statistically significantly larger than those in control group,respectively,while LVEF and CO in test group were statistically significantly higher than those in control group (P<0.05).(3)No statistically significant difference of incidence of adverse reactions was found between the two group

关 键 词：心肌梗死 血小板聚集 入院前急救 阿司匹林 氯吡格雷 心功能 心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]