本文選題：替格瑞洛 + 替非羅班��； 參考：《中國藥房》2017年32期

【摘要】：目的:比較氯吡格雷與替格瑞洛治療急性非ST段抬高型心肌梗死(NSTEMI)的臨床療效及安全性。方法:收集2013年10月-2015年11月我院心內科收治的NSTEMI患者160例,按隨機數字表法分為觀察組和對照組,各80例。兩組患者均給予常規(guī)治療,并以0.05μg/(kg·h)持續(xù)靜脈泵入鹽酸替非羅班氯化鈉注射液等,對照組在常規(guī)治療基礎上口服負荷劑量的硫酸氯吡格雷片300 mg,之后劑量改為75 mg,qd;觀察組在常規(guī)治療的基礎上口服負荷劑量的替格瑞洛片180 mg,之后改為90 mg,bid。兩組患者均治療1個月。比較兩組患者治療前后血小板集聚率、左室射血分數(LVEF)、左室舒張末期內徑(LVEDD)、纖維蛋白原水平,以及主要心血管事件(MACE)和出血事件發(fā)生率。結果:治療前,兩組患者血小板集聚率比較,差異無統計學意義(P0.05);治療1周及1個月后,兩組患者血小板集聚率顯著降低,且觀察組顯著低于對照組,差異均有統計學意義(P0.05)。治療1周后,兩組患者LVEF、LVEDD水平比較,差異無統計學意義(P0.05);治療1個月后,觀察組患者LVEF顯著升高,且顯著高于對照組,對照組患者LVEDD顯著降低且顯著低于觀察組,差異均有統計學意義(P0.05)。治療前、治療3 d后,兩組患者纖維蛋白原水平比較,差異無統計學意義(P0.05);治療1周、1個月后,兩組患者纖維蛋白原水平均顯著降低,且觀察組顯著低于對照組,差異均有統計學意義(P0.05)。觀察組患者MACE事件發(fā)生率為11.25%,顯著低于對照組的25.00%,差異有統計學意義(P0.05);兩組患者出血率比較(3.75%vs.7.50%),差異無統計學意義(P0.05)。結論:與氯吡格雷比較,替格瑞洛能有效抑制NSETMI患者血小板集聚,降低纖維蛋白原水平,提高心功能,改善預后,同時并未增加出血風險,安全性較高。
[Abstract]:Objective: to compare the efficacy and safety of clopidogrel and tigrilol in the treatment of acute non-St segment elevation myocardial infarction (NSTEMI). Methods: from October 2013 to November 2015, 160 patients with NSTEMI were randomly divided into two groups: observation group (n = 80) and control group (n = 80). The patients in both groups were treated with routine therapy and were continuously injected with tefebene hydrochloride sodium chloride injection with 0. 05 渭 g/(kg / h. In the control group, the loading dose of clopidogrel sulfate was 300 mg, then the dose was 75 mg / qd, and the observation group was treated with the loading dose of tigrilol 180 mg and 90 mg / kg respectively on the basis of routine treatment. Both groups were treated for 1 month. Platelet aggregation rate, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDDN), fibrinogen level, major cardiovascular events (MACEE) and incidence of bleeding events were compared between the two groups before and after treatment. Results: before treatment, there was no significant difference in platelet aggregation rate between the two groups, but after one week and one month of treatment, the platelet aggregation rate in the two groups was significantly lower than that in the control group, and the difference was statistically significant (P 0.05). After one week of treatment, there was no significant difference in LVEF and LVEDD levels between the two groups. After one month of treatment, the LVEF of the observation group was significantly higher than that of the control group, and the LVEDD of the control group was significantly lower and significantly lower than that of the observation group. The difference was statistically significant (P 0.05). Before and 3 days after treatment, there was no significant difference in fibrinogen level between the two groups, but the fibrinogen level in the observation group was significantly lower than that in the control group after one week and one month of treatment, and the level of fibrinogen in the two groups was significantly lower than that in the control group. The difference was statistically significant (P 0.05). The incidence of MACE events in the observation group was 11.25, which was significantly lower than that in the control group (25.00), the difference was statistically significant (P 0.05), and the bleeding rate of the two groups was 3.75 vs.7.50 and there was no significant difference between the two groups (P 0.05). Conclusion: compared with clopidogrel, tigrilol can effectively inhibit platelet aggregation, decrease fibrinogen level, improve cardiac function and improve prognosis in patients with NSETMI without increasing the risk of bleeding.
【作者單位】： 長沙市第一醫(yī)院心血管內科;
【分類號】：R542.22

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