替格瑞洛联合比伐芦定用于急诊PCI治疗AMI的临床效果研究  

Research on the clinical effect of ticagrelor combined with bivalirudin in the treatment of AMI with PCI

作　　者：郭楚锋 郭娟 夏小鹏[1] GUO Chu-feng;GUO Juan;XIA Xiao-peng(Department of Cardiology,the First Affiliated Hospital of Hunan College of Traditional Chinese Medicine,Zhuzhou Hunan 412000,China;Songshan Community Health Service Center,Zhuzhou Hunan 412000,China)

机构地区：[1]湖南中医药高等专科学校附属第一医院心血管内科,湖南株洲412000 [2]嵩山社区卫生服务中心,湖南株洲412000

出　　处：《临床和实验医学杂志》2020年第23期2517-2521,共5页Journal of Clinical and Experimental Medicine

基　　金：湖南省卫计委医学科研项目(编号:17ZX0065)。

摘　　要：目的研究替格瑞洛联合比伐芦定用于急诊经皮冠状动脉介入治疗(PCI)治疗急性心肌梗死(AMI)的临床效果。方法前瞻性将2018年1月至2019年11月在湖南中医药高等专科学校附属第一医院就诊的AMI患者按随机数字表法分为观察组(n=40)与对照组(n=41)。观察组给予替格瑞洛联合比伐芦定,对照组则应用氯吡格雷联合普通肝素。比较2组PCI手术情况;PCI术后TIMI血流分级情况;入院时、PCI术前即刻、术后即刻、术后4 h、术后24 h时的血小板反应指数(PRI);PCI术前、用药5 min、术后即刻、术后4 h及术后24 h时的激活全血凝固时间(ACT)变化情况;并统计术后30 d内不良事件发生率。结果2组PCI手术入径、梗死相关血管、病变血管支数、血栓抽吸比率、主动脉内气囊反搏(IABP)比率及PCI置入支架数差异无统计学意义(P>0.05),但观察组TIMI 3级比率显著高于对照组(92.50%vs.73.17%),差异有统计学意义(P<0.05);观察组术前即刻、术后即刻、术后4 h、术后24 h时的PRI值为(27.29±4.77)%、(14.60±3.35)%、(25.55±3.06)%、(24.77±5.65)%,均显著低于对照组[(44.46±7.48)%、(43.72±7.52)%、(43.94±7.38)%、(45.85±7.78)%],差异有统计学意义(P<0.05),术后即刻、术后24 h时的ACT值为(360.17±44.75)、(161.11±13.51)s,均显著高于对照组[(314.36±37.11)、(149.86±15.71)s],差异有统计学意义(P<0.05)。2组PCI术后30 d不良事件发生率无统计学意义(P>0.05)。结论替格瑞洛联合比伐芦定用于PCI治疗AMI具较好的短期抗凝效果,可明显降低血小板抑制指数并提升ACT,但远期获益与氯吡格雷联合普通肝素相当。Objective To research on the clinical effect of ticagrelor combined with bivalirudin in the treatment of acute myocardial infarction(AMI)with percutaneous coronary intervention(PCI).Methods The AMI patients treated in our hospital from January 2018 to November 2019 in the First Affiliated Hospital of Hunan College of Traditional Chinese Medicine were divided into the observation group(n=40)and the control group(n=41)according to the random number table method.The observation group was given ticagrelor combined with bivalirudin,and the control group were treated with clopidogrel combined with unfractionated heparin.PCI operation status in 2 groups.TIMI blood flow classification after PCI;platelet response index(PRI)at admission,immediately before PCI,immediately after surgery,4 h after surgery,and 24 h after surgery;active blood clotting time(ACT)at before PCI,5 minutes after medication,immediately after surgery,4 hours after surgery,and 24 hours after surgery were compared;and the incidence of adverse events within 30 days after surgery was counted.Results There were no statistically significant differences in the PCI surgical approach,infarct-related blood vessels,number of diseased vessels,thrombus aspiration ratio,intra-aortic balloon counterpulsation(IABP)ratio,and number of PCI stent placement between the two groups(P>0.05),but the proportion of TIMI grade 3 in the observation group was significantly higher than that in the control group(92.50%vs.73.17%),the difference was statistically significant(P<0.05);the PRI values of the observation group at immediate time before the surgery and after the surgery,4 h after the surgery,and 24 h after the surgery were(27.29±4.77)%,(14.60±3.35)%,(25.55±3.06)%,(24.77±5.65)%,which were significantly lower than those in the control group[(44.46±7.48)%,(43.72±7.52)%,(43.94±7.38)%,(45.85±7.78)%],the differencec was statistically significant(P<0.05).The ACT values at immediate time after the surgery and 24 hours after the surgery were(360.17±44.75),(161.11±13.51)s,wh

关 键 词：急性心肌梗死 替格瑞洛 比伐芦定 急诊经皮冠状动脉介入 

分 类 号：R542.22[医药卫生—心血管疾病]