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急诊PCI应用替格瑞洛与氯吡格雷序贯治疗对STEMI患者微血管损伤及CRP的影响
徐开平,王刚,简雪斌,邓喜庚,米伟
0
(西部战区空军医院急诊科)
摘要:
【摘要】目的 探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)治疗时使用替格瑞洛、氯吡格雷序贯治疗对微血管损伤与C反应蛋白(CRP)水平的影响。方法 选择2015年4月~2018年4月我院收治且拟行急诊PCI治疗的STEMI患者112例,随机分为观察组和对照组各56例。两组患者入组后均实施常规急诊PCI治疗,对照组使用氯吡格雷治疗,观察组使用替格瑞洛、氯吡格雷序贯治疗。观察两组患者术后微循环阻力指数(IMR)、冠状动脉血流储备(CFR)、血流储备分数(FFR),记录术前、术后2 h、术后24 h、术后7 d、术后30 d血小板聚集率和CRP水平,并统计术后30 d内不良心血管及出血事件发生率。结果 观察组术后IMR值低于对照组(P<005),两组患者CFR、FFR值比较差异无统计学意义(P>005)。两组患者不同时间段血小板聚集率和CRP水平比较差异统计学意义(P<005),且术后各时间段观察组血小板聚集率和CRP水平均低于对照组(P<005)。两组术后30 d内血管不良事件发生率低于对照组(P>005);两组术后30 d内出血事件发生率比较差异无统计学意义(P>005)。结论 STEMI患者急诊PCI治疗中应用替格瑞洛、氯吡格雷序贯治疗有助于减轻微血管损伤,抑制冠状动脉血管内炎症反应及血小板聚集,进而改善患者心功能,减少30 d内血管不良事件发生率,且不增加出血风险。
关键词:  急性心肌梗死  替格瑞洛  氯吡格雷  微血管损伤  C反应蛋白
DOI:
基金项目:四川省科技厅项目(2015S10326)
Effects of sequential therapy with ticagrelor and clopidogrel on microvascular injury and CRP level in patients with STEMI during emergency PCI
XU Kaiping,WANG Gang,JAN Xuebin,DENG Xigeng,MI Wei
(Department of Emergency, Air Force Hospital, Western War Zone)
Abstract:
【Abstract】Objective To study the effects of sequential therapy with ticagrelor and clopidogrel on microvascular injury and CRP level in patients with acute STsegment elevation myocardial infarction (STEMI) during emergency percutaneous coronary intervention (PCI). Methods 112 STEMI patients scheduled to undergo emergency PCI in our hospital from April 2015 to April 2018 were selected and randomly divided into observation group and control group, with 56 cases in each group. The two groups were given routine emergency PCI after entering the group. The control group was treated with clopidogrel, and observation group was given sequential therapy with ticagrelor and clopidogrel. The postoperative microcirculation resistance index (IMR), coronary flow reserve (CFR) and fractional flow reserve (FFR) were observed in the two groups. The platelet aggregation rate and Creactive protein (CRP) level were recorded before operation and at 2h, 24h, 7d and 30d after operation, and the incidence rates of adverse cardiovascular and hemorrhagic events within 30d after operation were counted. Results The postoperative IMR value in observation group was lower than that in control group (P<005), and the CFR and FFR values in the two groups were equivalent (P>005). There were significant differences in platelet aggregation rate and CRP level between the two groups (P<005), and the platelet aggregation rate and CRP level in observation group were lower than those in control group at each time period after operation (P<005). The incidence rate of vascular adverse events in observation group within 30d after operation was lower than that in control group (714% vs 2321%) (P>005). The incidence rate of hemorrhagic events in observation group within 30d after operation was equivalent to that in control group (893% vs 536%) (P>005). ConclusionSequential therapy with ticagrelor and clopidogrel in STEMI patients during emergency PCI can reduce microvascular injury, inhibit coronary vascular inflammatory response and platelet aggregation, improve cardiac function and reduce the incidence of vascular adverse events within 30d.
Key words:  Acute myocardial infarction  Ticagrelor  Clopidogrel  Microvascular injury  C reactive protein

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