本文選題：替格瑞洛 + 急性ST段抬高型心肌梗死��； 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討急診經(jīng)皮冠狀動脈介入治療(PCI)術(shù)前負荷量替格瑞洛對急性ST段抬高型心肌梗死(STEMI)患者的有效性和安全性。方法:連續(xù)入選2015年6月1日至2016年5月30日在廣西醫(yī)科大學第六附屬醫(yī)院入住診斷為STEMI的患者,按入院次序及隨機數(shù)字表分為替格瑞洛組(A組)和氯吡格雷組(B組)。PCI術(shù)前,所有患者給予負荷量阿司匹林(300 mg),此后每天100 mg維持,其中A組予負荷量替格瑞洛(180 mg),此后每次90 mg,每天2次維持,B組予負荷量氯吡格雷(300 mg),此后每次75 mg,每天1次維持。此外所有患者根據(jù)STEMI診治指南給予常規(guī)藥物治療。記錄兩組患者急診PCI術(shù)后罪犯冠狀動脈心肌梗死溶栓試驗(TIMI)血流情況,測定兩組患者用藥前、球囊擴張或血栓抽吸后、PCI術(shù)后24h及PCI術(shù)后7d血小板最大聚集率(MPA),并隨訪術(shù)后30d主要心血管不良事件(MACE)、出血事件和呼吸困難的發(fā)生情況。結(jié)果:1.本研究共篩選符合納入標準STEMI的患者208例,按入院次序及隨機數(shù)字表分為A組103例,B組105例。在隨訪期間A組有3例失訪,B組有1例失訪,最終入選A組100例,B組104例。兩組患者的臨床基礎(chǔ)資料包括年齡、性別、高血壓病、高脂血癥、糖尿病、吸煙、罪犯冠狀動脈、血管病變數(shù)和醫(yī)院就診至球囊擴張時間(D2B)比較差異無統(tǒng)計學意義(均P0.05),具有可比性。2.服藥前兩組患者的MPA均較高,但比較差異無統(tǒng)計學意義(P=0.441);球囊擴張或血栓抽吸后及PCI術(shù)后24h兩組MPA均有下降,A組下降更顯著,組間比較差異有統(tǒng)計學意義(均P0.001);PCI術(shù)后7d兩組MPA仍有下降,組內(nèi)與服藥前相比差異有統(tǒng)計學意義(均P0.001),雖然組間比較差異無統(tǒng)計學意義(P=0.267),但A組的MPA仍較B組低。3.PCI術(shù)后A組有6例無復流(6.0%),B組有20例(19.2%),組間比較差異有統(tǒng)計學意義(P=0.005)。4.兩組MACE的發(fā)生率各有不同,但總的MACE發(fā)生率組間比較差異無統(tǒng)計學意義(5.0%vs.6.7%,P=0.848)。5.兩組患者30d內(nèi)均未發(fā)生主要出血。A組患者有8例發(fā)生出血事件,1例次要出血,7例輕微出血,B組有4例出血事件,均為輕微出血。A組出血事件較B組多,但兩組出血事件發(fā)生率比較差異無統(tǒng)計學意義(8.0%vs.3.9%,P=0.288)。6.A組有7例出現(xiàn)呼吸困難,B組有3例出現(xiàn)呼吸困難,兩組間比較差異無統(tǒng)計學意義(7.0%vs.2.9%,P=0.245)。呼吸困難隨著用藥時間延長均可耐受,無需調(diào)整藥物或停藥。結(jié)論:替格瑞洛對血小板聚集抑制作用更快、更強,改善了STEMI患者急診PCI術(shù)后無復流,且不增加主要出血風險,在需急診介入治療的STEMI患者中應用是安全和有效的。
[Abstract]:Objective: to evaluate the efficacy and safety of emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: the patients who were admitted to the sixth affiliated Hospital of Guangxi Medical University from June 1, 2015 to May 30, 2016 were randomly divided into two groups: tigrillo group (group A) and clopidogrel group (group B). All patients were given a dose of aspirin (100mg / d after 300 mg),). Group A received tigrilol (90mg / day after 180 mg),) and group B received clopidogrel twice a day (75mg / day after 300 mg),). In addition, all patients were given routine medication according to STEMI guidelines. The thrombolytic test (TIMI) of coronary artery infarction (TIMI) was recorded in two groups after emergency PCI. The maximal platelet aggregation rate (MPA) was observed 24 hours after PCI and 7 days after PCI after balloon dilation or thrombus aspiration. The major adverse cardiovascular events (Mace), bleeding events and dyspnea were followed up 30 days after PCI. The result is 1: 1. A total of 208 patients with STEMI were selected and divided into group A (103 cases) and group B (105 cases) according to admission order and random number table. During the follow-up period, there were 3 cases of lost visit in group A and 1 case in group B, and 104 cases in group A (100 cases) and group B (104 cases). The clinical data of the two groups included age, sex, hypertension, hyperlipidemia, diabetes, smoking, coronary artery disease, There was no significant difference in the number of vascular lesions and the time of balloon dilation (D2B) between hospital and hospital (P0.05). The MPA of the two groups before PCI was higher, but the difference was not statistically significant (P0. 441), the MPA of the two groups after balloon dilatation or thrombus aspiration and 24 hours after PCI were lower than that of the control group (P < 0. 441). There was significant difference between the two groups (P0.001). The MPA of the two groups was still decreased 7 days after PCI. Although there was no significant difference between group A and group B (P0. 267), MPA in group A was still lower than that in group B. 3. There were 6 cases without reflow in group A (6. 0%), 20 cases (19. 2%) in group B, and 20 cases (19. 2%) in group B (P0. 005). The incidence of Mace was different between the two groups, but there was no significant difference in the total Mace incidence rate between the two groups (5.0 vs. 6.7P0. 848) .5. There were 8 cases of bleeding events in group A, 1 case of secondary hemorrhage, 7 cases of minor hemorrhage, 4 cases of hemorrhage in group B, and 4 cases of hemorrhage in group A, which were more than those in group B. However, there was no significant difference in the incidence of bleeding events between the two groups (8.0vs.3.9 and 0.288) .6.There were 7 cases of dyspnea in group A and 3 cases in group B, and there was no significant difference between the two groups (7.0vs.2.9). Dyspnea can be tolerated with the prolongation of medication, no need to adjust or stop medication. Conclusion: tigrilol has a faster and stronger inhibitory effect on platelet aggregation. It can improve no reflow after emergency PCI in STEMI patients and does not increase the risk of major bleeding. It is safe and effective in STEMI patients who need emergency interventional therapy.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R542.22

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