本文關(guān)鍵詞： 冠心病 急性ST段抬高型心肌梗死 替格瑞洛 經(jīng)皮冠狀動(dòng)脈介入治療 無(wú)復(fù)流現(xiàn)象　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:觀(guān)察急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者給予負(fù)荷劑量替格瑞洛對(duì)急診經(jīng)皮冠狀動(dòng)脈介入治療(Percutaneous coronary intervention,PCI)術(shù)中無(wú)復(fù)流現(xiàn)象(No reflow phenomenon,NRP)的影響。方法:本研究入選自2015年2月至2017年2月因急性STEMI就診于河北醫(yī)科大學(xué)第二醫(yī)院心內(nèi)科并行急診PCI治療的患者共122例。入院病人依據(jù)在急診科接受P2Y12ADP受體抑制劑的不同分為氯吡格雷組(n=69例),其中男性56例,女性13例,年齡在22-81歲(平均年齡59.61±12.59歲);替格瑞洛組(n=53例),其中男性49例,女性13例,年齡在22-82歲(平均年齡56.21±12.36歲)。氯吡格雷組患者急診PCI術(shù)前口服氯吡格雷300mg,術(shù)后常規(guī)以75mg 1/日。替格瑞洛組患者術(shù)前嚼服替格瑞洛180mg,術(shù)后常規(guī)以90mg 2/日。術(shù)后如無(wú)禁忌給予標(biāo)準(zhǔn)劑量硝酸酯類(lèi)、β受體阻滯劑、血管緊張素轉(zhuǎn)換酶抑制劑(ACEI)/血管緊張素Ⅱ受體拮抗劑(ARB)及他汀類(lèi)等藥物。觀(guān)察兩組基線(xiàn)資料及以下指標(biāo):(1)術(shù)中記錄心肌梗死癥狀發(fā)生至血管開(kāi)通時(shí)間、梗死相關(guān)動(dòng)脈、術(shù)前及術(shù)后TIMI血流、心肌灌注分級(jí)(TMPG)、梗死動(dòng)脈開(kāi)通時(shí)校正的TIMI幀數(shù)(CTFC)、術(shù)中抽吸導(dǎo)管及替羅非班應(yīng)用情況、支架長(zhǎng)度、支架直徑、無(wú)復(fù)流發(fā)生情況。(2)發(fā)病后每6小時(shí)測(cè)定肌酸激酶(Creatine Kinase,CK)、肌酸激酶同工酶(Creatine kinase isoenzyme,CK-MB)、肌鈣蛋白I(Cardiac troponin I,c Tn I),并記錄心肌酶峰值。(3)術(shù)后24小時(shí)(應(yīng)用替羅非班患者在停藥后8小時(shí)以上)測(cè)定血小板聚集率。術(shù)后1天完成心臟超聲檢查。(4)記錄患者住院期間主要不良事件事件。所有數(shù)據(jù)應(yīng)用SPSS 21軟件進(jìn)行數(shù)據(jù)處理分析,雙側(cè)P0.05定義為有統(tǒng)計(jì)學(xué)意義。結(jié)果:1兩組患者基線(xiàn)資料的比較兩組患者基線(xiàn)資料(年齡、性別、吸煙史、高血壓病史、糖尿病病史、血脂異常病史、術(shù)前收縮壓、舒張壓、心率、Killip分級(jí)、既往心肌梗死病史、既往PCI病史、梗死部位)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。兩組患者術(shù)前血糖、血鉀、總膽固醇、低密度脂蛋白膽固醇、肌酐、血小板計(jì)數(shù)、白細(xì)胞計(jì)數(shù)、血清BNP水平、超敏C反應(yīng)蛋白(hypersensitive C reactive protein,hs CRP)無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2兩組患者PCI相關(guān)參數(shù)兩組患者發(fā)病至梗死相關(guān)動(dòng)脈開(kāi)通時(shí)間、梗死相關(guān)動(dòng)脈分布、支架直徑、支架長(zhǎng)度、術(shù)前及術(shù)后TIMI 3級(jí)血流例數(shù)、TMPG3級(jí)血流例數(shù)、血栓抽吸例數(shù)、替羅非班應(yīng)用例數(shù)、造影劑用量差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。無(wú)復(fù)流發(fā)生比例術(shù)替格瑞洛組(9.4%vs.15.9%,P=0.29)低于氯吡格雷組,差異無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)后替格瑞洛組血小板聚集率(28.05±15.66 vs.37.96±20.09,P=0.003)替格瑞洛組低于氯吡格雷組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3兩組患者心肌酶峰值的比較術(shù)后替格瑞洛組CK峰值(2512±820.4U/Lvs.2678±1428U/L,P=0.45)、CK-MB峰值(290±91.6U/Lvs.292±106.7U/L,P=0.91)、c Tn I峰值(75.26±31.81ug/ml vs.80.1±32.33ug/ml,P=0.66)低于氯吡格雷組,差異無(wú)統(tǒng)計(jì)學(xué)意義。4術(shù)后24小時(shí)心臟超聲結(jié)果替格瑞洛組左室射血分?jǐn)?shù)(55.18±7.83vs.54.83±7.30,P=0.801)高于氯吡格雷組,差異無(wú)統(tǒng)計(jì)學(xué)意義。替格瑞洛組左室舒張末內(nèi)徑(52.04±4.70mm vs.53.07±4.90mm,P=0.92)低于氯吡格雷組,差異無(wú)統(tǒng)計(jì)學(xué)意義。5住院期間主要不良事件替格瑞洛組出現(xiàn)6例輕微出血,氯吡格雷組出現(xiàn)3例輕微出血,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。替格瑞洛組出現(xiàn)1例心力衰竭,氯吡格雷組出現(xiàn)2例心力衰竭,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。替格瑞洛組出現(xiàn)呼吸困難比例(0.136%vs.0.016%,P=0.01)高于氯吡格雷組,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:替格瑞洛可以在一定程度上減少急診PCI術(shù)中無(wú)復(fù)流發(fā)生。
[Abstract]:Objective: To observe the effect of acute ST elevation myocardial infarction (ST-segment elevation myocardial infarction, STEMI) were given a loading dose of ticagrelor in emergency percutaneous coronary intervention (Percutaneous coronary, intervention, PCI) with no reflow phenomenon (No reflow, phenomenon, NRP) effect. Methods: This study selected from February 2015 to enter in February 2017 due to acute STEMI treatment in the second hospital of Hebei Medical University Department of Cardiology underwent emergency PCI treatment in patients with a total of 122 cases of hospitalized patients. On the basis of P2Y12ADP receptor inhibitor in the emergency department is divided into clopidogrel group (n=69 cases), of which 56 were male, 13 were female, aged 22-81 years (mean age 59.61 + 12.59 years); ticagrelor group (n=53 cases), of which 49 were male, 13 were female, aged 22-82 years (mean age 56.21 + 12.36 years). Patients in clopidogrel group before emergency PCI oral clopidogrel Ray 300mg, 75mg 1/ with routine postoperative day. Ticagrelor group before chewing ticagrelor 180mg, postoperative routine with 90mg 2/. After the operation in the absence of contraindications given standard doses of nitrates, beta blockers, angiotensin converting enzyme inhibitors (ACEI) / angiotensin II receptor antagonist agent (ARB) and statin drugs. Two groups were observed at baseline and the following indicators: (1) myocardial infarction symptoms to patency time were recorded, the infarct related artery, preoperative and postoperative TIMI blood flow, myocardial perfusion grade (TMPG), the opening of the infarct artery corrected TIMI frame count (CTFC), intraoperative aspiration catheter and tirofiban application, stent length, stent diameter, the incidence of no reflow. (2) every 6 hours after the onset of the determination of creatine kinase (Creatine Kinase CK), creatine kinase isoenzyme (Creatine kinase isoenzyme, CK-MB I troponin (Cardiac), cardiac troponin I, C Tn I), And record the peak value of myocardial enzyme. (3) 24 hours after surgery (tirofiban in patients after discontinuation of 8 hours or more). The platelet aggregation rate was measured by echocardiography 1 days after operation. (4) records of patients with in-hospital major adverse event. All data using SPSS 21 software for data processing and analysis bilateral, P0.05 is defined as statistically significant. Results: compared two groups of patients with baseline data of 1 patients in the two groups at baseline data (age, gender, smoking history, hypertension, diabetes, dyslipidemia history, preoperative systolic blood pressure, diastolic blood pressure, heart rate, Killip grade, previous history of myocardial infarction, previous history of PCI. Infarct) there was no significant difference in total cholesterol (P0.05). Two groups of patients with preoperative blood glucose, serum potassium, low density lipoprotein cholesterol, creatinine, blood platelet count, white blood cell count, serum level of BNP, high sensitive C reactive protein (hypersensitive C reactive protein, HS CRP) had no statistical difference (P0.05).2 related artery in two groups of patients with PCI related parameters of two groups of patients with infarction onset to the opening time, the distribution of the infarct related artery stent diameter, stent length, preoperative and postoperative TIMI flow grade 3 cases, TMPG3 grade and number of cases, the number of cases of thrombus aspiration, tirofiban class application cases, there was no significant difference in the amount of contrast agent (P0.05). The incidence of no reflow ratio operation for Grillo group (9.4%vs.15.9%, P=0.29) than the clopidogrel group, the difference was not statistically significant. Postoperative ticagrelor group platelet aggregation rate (28.05 + 15.66 + 20.09 vs.37.96, P=0.003) ticagrelor group was lower than that of clopidogrel group, the difference was statistically significant (P0.05) compared with.3 two groups of myocardial enzymes in patients after peak ticagrelor group CK peak (2512 + 820.4U/Lvs.2678 + 1428U/L, P=0.45), the peak value of CK-MB (290 + 91.6U/Lvs.292 + 106.7U/L, P=0.91), C (75.26 + 31.81ug/ Tn I peak Ml vs.80.1 + 32.33ug/ml, P=0.66) than the clopidogrel group, there was no significant difference in 24 hours after.4 echocardiographic findings ticagrelor group left ventricular ejection fraction (55.18 + 7.83vs.54.83 + 7.30, P=0.801) was higher than that of clopidogrel group, the difference was not statistically significant. Ticagrelor group left ventricular end diastolic diameter (52.04 + 4.70mm vs.53.07 + 4.90mm, P=0.92) than the clopidogrel group, there was no statistically significant difference in in-hospital major adverse events.5 ticagrelor group had 6 cases of minor bleeding, clopidogrel group had 3 cases of minor bleeding, the difference was not statistically significant (P0.05). Ticagrelor group had 1 cases of heart failure, 2 cases of heart failure occurred clopidogrel group, no significant difference meaning (P0.05). Ticagrelor group appeared dyspnea ratio (0.136%vs.0.016%, P=0.01) is higher than that of clopidogrel group, the difference was statistically significant. Conclusion: for Grillo to a certain extent Reduction of no reflow during emergency PCI operation.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R542.22

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