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目的探讨术前负荷剂量替格瑞洛对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗(PCI)后心肌灌注的影响。方法选取2015年5月—2016年5月武汉市汉口医院收治的急性ST段抬高型心肌梗死患者80例,随机分为对照组和观察组,每组40例。两组患者均行急诊PCI术,术前30 min和术后1周对照组患者给予氯吡格雷,而观察组患者给予替格瑞洛。比较两组患者治疗后心肌梗死溶栓治疗临床试验(TIMI)分级、校正的TIMI帧数(CTFC)、心肌灌注分级(TMPG)、无复流/慢血流发生情况,住院期间及随访6个月出血事件、主要不良心血管事件(MACE)发生情况。结果观察组患者治疗后TIMI分级3级者所占比例、TMPG 3级者所占比例均高于对照组,CTFC少于对照组,无复流/慢血流发生率低于对照组(P<0.05)。住院期间两组患者出血事件、MACE发生率比较,差异无统计学意义(P>0.05);随访6个月,观察组患者MACE发生率低于对照组(P<0.05),而两组患者出血事件发生率比较,差异无统计学意义(P>0.05)。结论术前负荷剂量替格瑞洛可有效改善急性ST段抬高型心肌梗死患者PCI后心肌灌注。
Objective To investigate the effect of preoperative loading dose of ticagrelor on myocardial perfusion after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction. Methods Eighty patients with acute ST-segment elevation myocardial infarction admitted from May 2015 to May 2016 in Wuhan Hankou Hospital were randomly divided into control group and observation group, 40 cases in each group. Patients in both groups underwent emergency PCI. Patients in the control group received clopidogrel 30 min before surgery and 1 week after surgery, while patients in the observation group received ticagrelor. TIMI grade, corrected TIMI frames (CTFC), myocardial perfusion grading (TMPG), no-reflow / slow blood flow, hospitalization and follow-up were compared between the two groups after treatment On-month bleeding events, major adverse cardiovascular events (MACE). Results The TIMI grade 3 grade, TMPG grade 3 grade in the observation group were higher than those in the control group, CTFC less than the control group, and the incidence of no-reflow / slow blood flow was lower than that in the control group (P < 0.05). There was no significant difference in the incidence of bleeding and MACE between the two groups during hospitalization (P> 0.05). After 6 months of follow-up, the incidence of MACE in the observation group was lower than that of the control group (P <0.05) Incidence rate comparison, the difference was not statistically significant (P> 0.05). Conclusion Preoperative loading dose of ticagrelor can effectively improve myocardial perfusion in patients with acute ST-segment elevation myocardial infarction.