CAJ | 학술논문

目的探讨替格瑞洛在急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PCI)治疗中的临床疗效及安全性.方法 2013年1月至2014年7月我院心脏内科收治的174例接受急诊PCI的STEMI死患者,随机分为氯吡格雷组88例(术前顿服氯吡格雷600 mg)和替格瑞洛组86例(术前顿服替格瑞洛180 mg).比较两组血小板抑制率,术前、术后肾功能,术后30 d主要临床心血管事件及出血事件,药物不良反应情况.结果 (1)两组患者花生四烯酸途径抑制率相比,差异无统计学意义(P＞0.05);两组患者二磷酸腺苷途径抑制率相比,替格瑞洛组(71.82±19.97)％明显升高,且高于氯吡格雷组(38.96±27.55)％,差异有统计学意义(t=-7.569,P＜0.001).(2)两组主要心血管事件相比,替格瑞洛组(5例)较氯吡格雷组(15例)减少,两组间比较差异有统计学意义(P=0.02);两组出血事件相比,替格瑞洛组(15例)与氯吡格雷组(11例)之间比较差异无统计学意义(P=0.617).结论替格瑞洛在急性STEMI患者直接PCI治疗中的效果优于氯吡格雷,可减少患者心血管事件风险,且不增加严重出血.
목적 탐토체격서락재급성ST단태고형심기경사(STEMI)환자직접경피관상동맥개입(PCI)치료중적림상료효급안전성.방법 2013년1월지2014년7월아원심장내과수치적174례접수급진PCI적STEMI사환자,수궤분위록필격뢰조88례(술전돈복록필격뢰600 mg)화체격서락조86례(술전돈복체격서락180 mg).비교량조혈소판억제솔,술전、술후신공능,술후30 d주요림상심혈관사건급출혈사건,약물불량반응정황.결과 (1)량조환자화생사희산도경억제솔상비,차이무통계학의의(P＞0.05);량조환자이린산선감도경억제솔상비,체격서락조(71.82±19.97)％명현승고,차고우록필격뢰조(38.96±27.55)％,차이유통계학의의(t=-7.569,P＜0.001).(2)량조주요심혈관사건상비,체격서락조(5례)교록필격뢰조(15례)감소,량조간비교차이유통계학의의(P=0.02);량조출혈사건상비,체격서락조(15례)여록필격뢰조(11례)지간비교차이무통계학의의(P=0.617).결론 체격서락재급성STEMI환자직접PCI치료중적효과우우록필격뢰,가감소환자심혈관사건풍험,차불증가엄중출혈.
Objective To observe the clinical efficacy and safety of ticagrelor,a new antiplatelet agent,in patients with ST-Segment elevation myocardial infarction (STEMI) underwent emergency PCI.Methods Selected 174 patients with STEMI receiving emergency PCI treatment from January 2013 to July 2014 in Nanjing General Hospital of Nanjing Military Area Command,and randomly divided into clopidogrel group (preoperative taking 600 mg of clopidogrel,n =88) and ticagrelor group (preoperative taking 180 mg of ticagrelor,n =86).Compared platelet inhibition rate,renal function before and after treatment,major clinical cardiovascular events and bleeding events 30 d after treatment,adverse drug reactions of two groups.Results (1) Arachidonic acid pathway inhibition rate of the two groups were compared,the difference was not statistically significant (P ＞0.05).Compared two groups of patients with adenosine phosphate pathway inhibition rate,ticagrelor group was higher,the difference was statistically significant ((71.82 ± 19.97) ％ vs.(38.96 ± 27.55) ％;t =-7.569,P ＜0.001).(2) Compared major cardiovascular events of ticagrelor group(5 cases) and clopidogrel group (15 cases),ticagrelor group was decreased.There was significant differences (P =0.02) between the two groups.Bleeding events compared to between ticagrelor group (15 cases) and clopidogrel group (11 cases),no statistically significant difference was found(P =0.617).Conclusion Clinical efficacy of ticagrelor in acute ST-segment elevation myocardial infarction treated with primary PCI is superior to clopidogrel in which can reduce the risk of cardiovascular events in patients and without an increase in severe bleeding.