替格瑞洛应用于老年急性冠脉综合征直接经皮冠状动脉介入术后真实世界中的疗效研究  

Application of ticagrelor in elder patients with acute coronary syndrome after PCI——an efficiency study in real world

作　　者：马铄 黄浩[1] 韩虎魁 陈旸[1] MA Shuo;HUANG Hao;HAN Hu-Kui;CHEN Yang(Department of Cardiovascular,Sichuan Academy of Medical Sciences&Sichuan Provincial People s Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院心内科,四川成都610072

出　　处：《实用医院临床杂志》2021年第3期13-16,共4页Practical Journal of Clinical Medicine

基　　金：四川省干部保健科研课题资助课题(编号:川干研2017-218)。

摘　　要：目的评估替格瑞洛对接受直接经皮冠状动脉介入术(PCI)的急性冠脉综合征(ACS)老年患者在抗血小板治疗的临床有效性及安全性。方法通过电子病历系统查询诊断为ACS并行直接PCI的老年患者121例,按服用药物种类分为氯吡格雷组(61例)和替格瑞洛组(60例)。比较分析替格瑞洛组和氯吡格雷组围手术期术后高敏C反应蛋白(hs-CRP)水平。比较两组1年内主要不良心血管事件(包括再发心绞痛、心肌梗死、支架内血栓形成、再次行PCI术、心力衰竭、心源性死亡)和药物不良反应(包括出血、呼吸困难、心动过缓)发生情况。结果替格瑞洛组治疗第7天hs-CRP炎症因子水平明显低于氯吡格雷组,差异有统计学意义(P<0.01)。1年内替格瑞洛组总的主要不良心血管事件发生率较氯吡格雷组低,差异有统计学意义(P<0.05),轻中度呼吸困难发生率较氯吡格雷组增高,且差异有统计学意义(P<0.05)。两组患者总不良反应事件差异无统计学意义(P>0.05)。结论老年急性冠脉综合征人群介入术后使用替格瑞洛抗血小板及抗炎作用明显强于氯吡格雷,需警惕有轻中度呼吸困难及出血等不良反应。Objective To evaluate the clinical efficacy and safety of ticagrelor for antiplatelet in old age patients with acute coronary syndrome undergoing direct percutaneous coronary intervention(PCI).Methods One hundred and twenty-one old age patients diagnosed with acute coronary syndrome(ACS),who underwent direct PCI,wereselected by using the electronic medical record system.The patients were divided into ticagrelor group(n=60)and clopidogrel group(n=61)according to the type of medication taken.The levels of serum high sensitive C reaction protein(hs-CRP)were analyzed in perioperative and postoperative period of PCI.The patients were followed up for 12 months after medication.Main adverse cardiovascular events such as recurrent angina pectoris,myocardial infarction,stent thrombosis,revascularization of target vessels,cardiac insufficiency and cardiac death were compared between the two groups.Adverse drug reactions such as haemorrhage,dyspnea and bradycardia were also compared between the two groups.Results The levels of hs-CRP were significantly lower in the ticagrelor group than that in the clopidogrel group after7 days of PCI(P<0.01).The total incidences of main adverse cardiovascular events in the ticagrelor group were significantly lower than those in the clopidogrel group(P<0.05)while the incidences of mild dyspnea and bleeding in the ticagrelor group were statistically higher than those in the clopidogrel group within one year.There was no significant difference in total adverse events between the two groups(P>0.05).Conclusion The antiplatelet and anti-inflammatory effect of ticagrelor is superior to clopidogrel in old age patients with ACS.However,it is necessary to be alert for minor adverse reactions such as dyspnea and bleeding.

关 键 词：老年 经皮冠状动脉介入术 替格瑞洛 

分 类 号：R541.4[医药卫生—心血管疾病]