不同抗血小板药物治疗STEMI患者的疗效比较  

Comparison of therapeutic effects of different antiplatelet therapies on patients with acute ST segment elevation myocardial infarction

作　　者：张小乐[1] 苏永才[1] 黄志锋[1] 杨春万[1] ZHANG Xiao-le;SU Yong-cai;HUANG Zhi-feng;YANG Chun-wan(CCU,First People′s Hospital of Zhaoqing City,Zhaoqing,Guangdong,526021,China)

机构地区：[1]肇庆市第一人民医院CCU,广东肇庆526021

出　　处：《心血管康复医学杂志》2021年第1期38-41,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:研究对比不同抗血小板治疗对急性ST段抬高型心肌梗死(STEMI)患者的疗效和安全性。方法:选择在本院行急诊冠脉介入治疗的STEMI患者201例,根据给予的抗血小板治疗药物分为替格瑞洛组(103例)和氯吡格雷组(98例),对比两组患者给药后2h和6h应用血栓弹力图测定二磷酸腺苷(ADP)受体途径及花生四烯酸途径诱导的血小板抑制率和介入术中慢血流及住院期间出血并发症发生率。结果:两组:与服药后2h比较,服药后6h花生四烯酸途径和ADP受体途径诱导的血小板抑制率均显著提高(P均=0.001),与氯吡格雷组比较,替格瑞洛组在服药2h及6h后的ADP受体途径诱导的血小板抑制率均显著提高[2h:(42.17±4.84)%比(55.81±5.69)%,6h:(59.51±4.55)%比(78.51±4.26)%,P均=0.001];在服药后2h和6h两组间花生四烯酸途径诱导的血小板抑制率无显著差异(P均>0.05)。两组患者介入术中慢血流及出血发生率均无显著差异(P均>0.05)。结论:对STEMI患者给予替格瑞洛或氯吡格雷均能显著抑制血小板,替格瑞洛较氯吡格雷更能快速充分抑制血小板,并且不增加患者出血风险。Objective:To compare clinical effectiveness and safety of different antiplatelet therapies on patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:According to given antiplatelet drugs,a total of 201 STEMI patients undergoing emergent PCI in our hospital were divided into ticagrelor group(n=103)and clopidogrel group(n=98).Adenosine diphosphate(ADP)receptor pathway and arachidonic acid(AA)pathway induced platelet inhibition rates(PIR)on 2h and 6h after administration measured by thromboelastogram(TEG)and incidence rates of intraoperative slow flow and bleeding complications during hospitalization were compared between two groups.Results:In two groups,compared with 2h after administration,there were significant rise in AA pathway and ADP receptor pathway induced PIR in two groups on 6h after administration(P=0.001 all).Compared with clopidogrel group,there was significant rise in ADP receptor pathway induced PIR[2h:(42.17±4.84)%vs.(55.81±5.69)%,6h:(59.51±4.55)%vs.(78.51±4.26)%]in ticagrelor group on 2h and 6h after administration,P=0.001 both;there was no significant difference in AA pathway induced PIR between two groups on 2h and 6h after administration,P>0.05 both.There were no significant difference of slow blood flow and bleeding rate in PCI between two groups.Conclusion:Either ticagrelor or clopidogrel can significantly inhibit platelets in STEMI patients.Compared with clopidogrel,ticagrelor can inhibit platelets more rapidly and fully without increasing bleeding risk.

关 键 词：心肌梗死 血小板聚集抑制剂 血管成形术 气囊 冠状动脉 

分 类 号：R542.22[医药卫生—心血管疾病]