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替格瑞洛辅助急诊PCI治疗STEMI对患者心室重构影响情况分析
Effect of ticagrelor on ventricular remodeling in patients with STEMI undergoing emergency PCI
- 第三军医大学学报 2017年39卷第21期 页码：2126-2130
- 作者机构：
362000 福建 泉州，福建医科大学附属泉州第一医院心内科
- 作者简介：
[王凌，E-mail：cindy0824cc@163.comWANG Lin, E-mail:cindy0824cc@163.com
- 基金信息：
DOI：10.16016/j.1000-5404.201705021
中图分类号： R540.45;R542.22;R973.2收稿：2017-05-04，
修回：2017-07-12，
纸质出版：2017-11-15
- 稿件说明：
移动端阅览
王凌, 郭浪滔, 洪序溪. 替格瑞洛辅助急诊PCI治疗STEMI对患者心室重构影响情况分析[J]. 第三军医大学学报, 2017,39(21):2126-2130.
Ling WANG, Langtao GUO, Xuxi HONG. Effect of ticagrelor on ventricular remodeling in patients with STEMI undergoing emergency PCI[J]. Journal of Third Military Medical University, 2017, 39(21): 2126-2130.
王凌, 郭浪滔, 洪序溪. 替格瑞洛辅助急诊PCI治疗STEMI对患者心室重构影响情况分析[J]. 第三军医大学学报, 2017,39(21):2126-2130. DOI： 10.16016/j.1000-5404.201705021.
Ling WANG, Langtao GUO, Xuxi HONG. Effect of ticagrelor on ventricular remodeling in patients with STEMI undergoing emergency PCI[J]. Journal of Third Military Medical University, 2017, 39(21): 2126-2130. DOI： 10.16016/j.1000-5404.201705021.
摘要
目的
2
探讨ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)行急诊经皮冠脉介入术(percutaneous coronary intervention，PCI)患者加用替格瑞洛治疗的临床效果及对患者心室重构的影响。
方法
2
选取我院急诊PCI手术治疗的STEMI患者120例(2014年1月至2016年8月)进行回顾性分析，患者均急诊PCI手术，根据治疗药物分为两组，60例患者术前及术后均给予替格瑞洛(替格瑞洛组)、60例患者术前及术后均给予氯吡格雷(氯吡格雷组)，对比两组患者术后心室重构指标、心电图等指标。
结果
2
术后12周，替格瑞洛组LVEDd(49.1±5.4)mm、LVESD(40.6±4.6)mm、LVMI(112.8±11.0)g/m
2
、LVMW(140.7±18.5)g低于氯吡格雷组患者LVEDd(53.1±4.6)mm、LVESD(43.9±4.7)mm、LVMI(118.2±9.4)g/m
2
、LVMW(153.0±21.3)g(
t
=4.638、
t
=3.887、
t
=2.891、
t
=2.198，
P
均
<
0.05)，两组患者的LVEF值差异无统计学意义(
t
=1.064，
P
>
0.05)；术后12周，替格瑞洛组Tp-e(114.2±12.7)ms、Tp-e/QTc(0.20±0.05)低于氯吡格雷组患者Tp-e(120.6±13.9)ms、Tp-e/QTc(0.25±0.07)(
t
=2.633、
t
=4.502，
P
<
0.05)；替格瑞洛组的不良心血管事件发生率6.67%与氯吡格雷组的13.33%比较，差异无统计学意义(χ
2
=1.481，
P
>
0.05)。
讨论
2
STEMI行PCI患者加用替格瑞洛治疗能有效减轻心室重构，改善心电图指标。
Abstract
Objective
2
To investigate the clinical efficacy of ticagrelor in treatment of ST-segment elevation myocardial infarction (STEMI) patients before and after emergency percutaneous coronary intervention (PCI)
and determine its effect on the ventricular remodeling.
Methods
2
A retrospective analysis was conducted on 120 STEMI patients who underwent emergency PCI in our hospital from January 2014 to August 2016. According to their drug treatment
they were divided into ticagrelor group (
n
=60
given ticagrelor pre-and post-operatively) and clopidogrel group (
n
=60
given clopidogrel pre-and post-operatively). The ind
exes of ventricular remodeling
electrocardiography (ECG) parameters and other indexes were compared between the 2 groups.
Results
2
In 12 weeks after operation
the ticagrelor group had significantly lower left ventricular end diastolic diameter (LVEDd
49.1±5.4
vs
53.1±4.6 mm
t
=4.638
P
<
0.05)
left ventricular end systolic diameter (LVESD
40.6±4.6
vs
43.9±4.7 mm
t
=3.887
P
<
0.05)
left ventricular mass index (LVMI
112.8±11.0
vs
118.2±9.4 g/m
2
t
=2.891
P
<
0.05)
and left ventricular mass (LVMW
140.7±18.5
vs
153±21.3 g
t
=2.198
P
<
0.05) when compared with the clopidogrel group. But no difference was seen in left ventricular ejection fraction (LVEF) between them (
t
=1.064
P
>
0.05). What's more
the T wave (Tp-e) interval and the Tp-e/QT ratio were obviously lower in the ticagrelor group than the other group (114.2±12.7
vs
120.6±13.9 ms
t
=2.633
P
<
0.05; 0.20±0.05
vs
0.25±0.07
t
=4.502
P
<
0.05). There was no notable difference in the incidence of adverse cardiovascular events between them (6.67%
vs
13.33%
Chi
-square=1.481
P
>
0.05).
Conclusion
2
Additional ticagrelor treatment can effectively reduce ventricular remodeling and improve ECG indicators in STEMI patients undergoing PCI.
关键词
Keywords
references
BODY R, BURROWS G, CARLEY S, et al. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a sensitive troponin I assay[J]. Annals of Clinical Biochemistry, 2015, 52(Pt 5): 543.
HJALMARSON A, HERLITZ J, HOLMBERG S, et al. The Goteborg metoprolol trial. Effects on mortality and morbidity in acute myocardial infarction[J]. Circulation, 1983, 67(6 Pt 2): I26-32.
农京国, 田进文, 彭亮, 等.冠状动脉内逆向精确溶栓术在急性ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗中应用的研究[J].中国循环杂志, 2016, 31(12): 1160-1164. DOI:10.3969/j.issn.1000-3614.2016.12.004.
NONG J G, TIAN J W, PENG L, et al. Application of Precise Intracoronary Retrograde Thrombolysis During Primary PCI in Patients With Acute ST-segment Elevation Myocardial Infarction[J]. Chin Circul J, 2016, 31(12): 1160-1164. DOI:10.3969/j.issn.1000-3614.2016.12.004.
吴佳纬, 马礼坤, 杨喆, 等.比伐芦定在急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术中应用的疗效观察[J].中国循环杂志, 2015, 30(8): 737-740. DOI: 10.3969/j.issn.1000-3614.2015.08.005.
WU J W, MA L K, YANG Z, et al. Effect of Bivalirudin on Primary Percutaneous Coronary Intervention in Patients With Acute ST-elevation Myocardial Infraction[J]. Chin Circul J, 2015, 30(8): 737-740. DOI: 10.3969/j.issn.1000-3614.2015.08.005.
张明亮, 沈玉华, 王环宇, 等.替格瑞洛与氯吡格雷序贯治疗对STEMI急诊PCI患者血小板聚集率及MACE的影响[J].中国循证心血管医学杂志, 2016, 8(3): 331-334. DOI: 10.3969/j.issn.1674-4055.2016.03.22.
ZHANG M L, SHEN Y H, WANG H Y, et al.Influence of sequential therapy of ticagrelor and clopidogrel on platelet aggregation rate and major adverse cardiovascular events in patients with STEMI undergone emergency PCI[J]. Chin J Evidence-Based Cardiovasc Med, 2016, 8(3): 331-334. DOI: 10.3969/j.issn.1674-4055.2016.03.22.
丁玲岩, 马志芳. P2Y12受体拮抗剂替格瑞洛的临床应用[J].国际心血管病杂志, 2016, 43(1): 35-38. DOI:10.3969/j.issn.1673-6583.2016.01.011.
DING L Y, MA Z F. Clinical application of P2Y12 receptor antagonist[J]. Inter J Cardiovasc Dis, 2016, 43(1): 35-38. DOI: 10.3969/j.issn.1673-6583.2016.01.011.
KERN M J, MOORE J A, AGUIRRE F V, et al. Determination of angiographic (TIMI grade) blood flow by intracoronary Doppler flow velocity during acute myocardial infarction[J]. Circulation, 1996, 94(7): 1545-1552. DOI: 10.1161/01.cir.94.7.1545.
KOCKA V, MALY M, TOUSEK P, et al. Bioresorbable vascular scaffolds in acute ST-segment elevation myocardial infarction: a prospective multicentre study 'Prague 19'[J]. Eur Heart J, 2014, 35(12): 787-794. DOI: 10.1093/eurheartj/eht545.
LEE K H, JEONG M H, AHN Y, et al. One-year clinical impact of cardiac arrest in patients with first onset acute ST-segment elevation myocardial infarction[J]. Int J Cardiol, 2014, 175(1): 147-153. DOI: 10.1016/j.ijcard.2014.05.002.
彭文华, 王勇, 李宪伦, 等.双血管急性闭塞的急性ST抬高型心肌梗死的冠状动脉间血流灌注影响[J].中华急诊医学杂志, 2015, 24(4): 397-400. DOI:10.3760/cma.j.issn.1671-0282.2015.04.013.
PENG W H, WANG Y, LI X L, et al. A retrospective analysis of blood flow perfusion among coronary arteries during double vessel acute simultaneous occlusion in acute ST-elevation myocardial infarction patients[J]. Chin J Emerg Med, 2015, 24(4): 397-400. DOI:10.3760/cma.j.issn.1671-0282.2015.04.013.
赵飞, 李录华, 王学军, 等.浅谈急性心肌梗死的院前急救与护理[J].中国医学装备, 2014, 11(S1): 44-45.
ZHAO F, LI L H, WANG X J, et al. Prehospital care and nursing of acute myocardial infarction[J]. China Med Equip, 2014, 11(S1): 44-45.
何华, 董道然, 李楠, 等.缺血后适应对急性心肌梗死患者急诊经皮冠状动脉介入术后早期心肌保护作用研究[J].中国医药, 2015, 10(6): 777-781. DOI:10.3760/cma.j.issn.1673-4777.2015.06.003.
HE H, DONG D R, LI N, et al. Cardio-protective effect of ischemic post-conditioning in patients with acute myocardial infarction after emergency percutaneous coronary interventi[J]. China Med, 2015, 10(6): 777-781. DOI:10.3760/cma.j.issn.1673-4777.2015.06.003.
周发展, 宋兆峰, 刘即芳, 等.急诊经皮冠状动脉介入治疗术前负荷瑞舒伐他汀和应用替罗非班对心肌再灌注损伤及预后的影响[J].中国医药, 2015, 10(10): 1413-1417. DOI: 10.3760/cma.j.issn.1673-4777.2015.10.002.
ZHOU F Z, SONG Z F, LIU J F, et al. Effect of high-loading-dosage of rosuvastatin and tirofiban before percutaneous coronary intervention on myocardial reperfusion injury[J]. China Med, 2015, 10(10): 1413-1417. DOI: 10.3760/cma.j.issn.1673-4777.2015.10.002.
杨靖, 崔海明, 任雨笙, 等.丹红注射液治疗ST段抬高型心肌梗死直接经皮冠状动脉介入术后无复流/慢血流的研究[J].世界中西医结合杂志, 2015, 10(2): 210-213, 225. DOI: 10.13935/j.cnki.sjzx.150220.
YANG J, CUI H M, REN Y S, et al. Danhong injection in patients with no-reflow/slow-flow following primary PCI of ST-segment elevation myocardial infarction[J]. World J Integr Tradit West Med, 2015, 10(2): 210-213, 225. DOI: 10.13935/j.cnki.sjzx.150220.
李军, 杨小月, 屈家祥, 等.比伐卢定与替罗非班合用肝素在急诊经皮冠状动脉介入治疗中的疗效[J].中国老年学杂志, 2014, 34(14): 3902-3904. DOI: 10.3969/j.issn.1005-9202.2014.14.044.
LI J, YANG X Y, QU J X, et al. Efficacy of bivalirudin combined with tirofiban combined with heparin in percutaneous coronary intervention[J]. Chin J Gerontol, 2014, 34(14): 3902-3904. DOI: 10.3969/j.issn.1005-9202.2014.14.044.
孙秀波, 付春毅, 张亚同, 等.新型抗血小板聚集药物——替格瑞洛的研究进展[J].中国药房, 2015, 26(14): 2010-2013.
SUN X B, FU C Y, ZHANG Y T, et al. Advances in research on the new antiplatelet aggregation drug-tegrelol[J]. China Pharm, 2015, 26(14): 2010-2013.
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