本文選題：替格瑞洛　切入點(diǎn)：氯吡格雷　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:評(píng)價(jià)行擇期經(jīng)皮冠狀動(dòng)脈介入治療(Percutaneous coronary intervention,PCI)術(shù)的急性冠脈綜合征(Acute coronary syndrome,ACS)患者圍手術(shù)期不同抗栓方案的有效性及安全性。方法:選擇2014年12月-2016年6月在河北醫(yī)科大學(xué)第二醫(yī)院診治為ACS并行擇期PCI的患者280例,隨機(jī)分為四組,氯吡格雷聯(lián)合比伐盧定組(C1),替格瑞洛聯(lián)合比伐盧定組(T1),氯吡格雷聯(lián)合普通肝素組(Unfractionated heparin,UFH)(C2),替格瑞洛聯(lián)合普通肝素組(T2);比較四組間30天的心血管不良事件(Major adverse cardiovascular events,MACE)及出血事件發(fā)生率并且評(píng)估影響預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)果:四組30天的MACE發(fā)生率未見明顯差異(?2=2.214,P=0.529),但是生存函數(shù)曲線顯示T1的生存率高于其他三組的生存率;四組間30天的嚴(yán)重出血事件的發(fā)生率未見明顯差異(?2=2.75,P=0.432)。四組患者在輕微出血發(fā)生率有統(tǒng)計(jì)學(xué)意義(?2=8.400,P=0.038)。COX回歸分析顯示,糖尿病(OR=6.96,CI95%1.92-25.26),高血脂(OR=6.56,CI95%1.82-23.55),吸煙(OR=3.77,CI95%1.09-12.98)是發(fā)生MACE的獨(dú)立危險(xiǎn)因素。結(jié)論:術(shù)前應(yīng)用替格瑞洛聯(lián)合術(shù)中比伐盧定,不增加ACS擇期PCI患者30天MACE事件發(fā)生率,但有升高生存率的趨勢。輕微出血的風(fēng)險(xiǎn)增加,但不增加嚴(yán)重出血的風(fēng)險(xiǎn)。糖尿病、高脂血癥、吸煙是這部分患者發(fā)生MACE事件的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to evaluate the efficacy and safety of different antithrombotic regimens in patients with acute coronary syndrome (ACS) undergoing elective percutaneous coronary intervention (PCI). Methods: from December 2014 to June 2016 in Hebei Province. 280 patients with ACS and selective PCI were treated in the second Hospital of Medical University. They were randomly divided into four groups. Clopidogrel combined with bivaludine, tigrilol combined with bivaludine, clopidogrel combined with common heparin, unfractionated heparin, tigrilol combined with common heparin, tigrilol combined with common heparin were compared with each other for 30 days of major adverse cardiovascular events (MACEE). The incidence of blood events and the evaluation of independent risk factors affecting prognosis. Results: there was no significant difference in the incidence of MACE in the four groups at 30 days. The survival rate of T1 was higher than that of the other three groups, but there was no significant difference in the incidence of severe bleeding events in 30 days between the four groups. The incidence of slight hemorrhage in the four groups was significantly higher than that in the control group. 2 regression analysis showed that the risk factors of MACE were 6.96% CI951.92-25.26, 6.56% CI951.82-23.55, and 3.77% CI951.09-12.98). Conclusion: the incidence of 30 days MACE events in patients with ACS PCI was not increased by using tigrilol combined with varicatine during operation. But there was a tendency to increase the survival rate. The risk of mild bleeding increased, but not the risk of severe bleeding. Diabetes, hyperlipidemia, and smoking were independent risk factors for MACE events in these patients.
【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
【分類號(hào)】：R541.4

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