CAJ | 학술논문

目的：探讨替格瑞洛对急性 ST 段抬高型心肌梗死（ASTEMI）患者急诊经皮冠状动脉介入治疗（PCI）术中慢血流的影响。方法选择2014年9月—2015年2月在第四军医大学西京医院就诊的 ASTEMI 患者78例，均行急诊 PCI。将所有患者随机分为观察组38例和对照组40例。观察组患者在急诊 PCI 术前给予替格瑞洛、阿司匹林口服治疗，对照组患者在急诊 PCI 术前给予硫酸氢氯吡格雷、阿司匹林口服治疗。比较两组患者支架置入前后 TIMI 血流分级，术中慢血流发生情况及住院期间不良临床事件发生情况。结果两组患者支架置入前 TIMI 血流分级比较，差异无统计学意义（P >0.05）；观察组患者支架置入后 TIMI 血流分级优于对照组（P <0.05）。观察组患者术中慢血流发生率为7.9%，低于对照组的30.0%（P <0.05）。住院期间对照组2例患者死亡，观察组1例患者死亡，死因均为广泛前壁心肌梗死、心源性休克。观察组患者住院期间不良临床事件发生率为13.1%，低于对照组的32.5%（P <0.05）。结论术前口服替格瑞洛可降低 ASTEMI 患者急诊 PCI 术中慢血流发生率，且不增加住院期间不良临床事件发生风险，安全性较高。
목적：탐토체격서락대급성 ST 단태고형심기경사（ASTEMI）환자급진경피관상동맥개입치료（PCI）술중만혈류적영향。방법선택2014년9월—2015년2월재제사군의대학서경의원취진적 ASTEMI 환자78례，균행급진 PCI。장소유환자수궤분위관찰조38례화대조조40례。관찰조환자재급진 PCI 술전급여체격서락、아사필림구복치료，대조조환자재급진 PCI 술전급여류산경록필격뢰、아사필림구복치료。비교량조환자지가치입전후 TIMI 혈류분급，술중만혈류발생정황급주원기간불량림상사건발생정황。결과량조환자지가치입전 TIMI 혈류분급비교，차이무통계학의의（P >0.05）；관찰조환자지가치입후 TIMI 혈류분급우우대조조（P <0.05）。관찰조환자술중만혈류발생솔위7.9%，저우대조조적30.0%（P <0.05）。주원기간대조조2례환자사망，관찰조1례환자사망，사인균위엄범전벽심기경사、심원성휴극。관찰조환자주원기간불량림상사건발생솔위13.1%，저우대조조적32.5%（P <0.05）。결론술전구복체격서락가강저 ASTEMI 환자급진 PCI 술중만혈류발생솔，차불증가주원기간불량림상사건발생풍험，안전성교고。
Objective To investigate the impact of ticagrelor on coronary slow flow(CSF)during emergency PCI in patients with acute ST segment elevation myocardial infarction(ASTEMI). Methods A total of 78 patients with ASTEMI were selected in Xijing Hospital of the Fourth Military Medical University from September 2014 to February 2015,all of them received emergency PCI,and they were randomly divided into control group( n = 38)and observation group( n = 40). Patients of control group were given oral clopidogrel bisulfate and aspirin before emergency PCI,while patients of observation group were given oral ticagrelor and aspirin before emergency PCI. TIMI flow grade before and after stent implantation,incidence of CSF during emergency PCI and incidence of adverse clinical events during hospitalization were compared between the two groups. Results No statistically significant differences of TIMI flow grade was found between the two groups before stent implantation(P> 0. 05),while TIMI flow grade of observation group was statistically significantly better than that of control group after stent implantation(P < 0. 05). The incidence of CSF during emergency PCI of observation group was 7. 9% ,was statistically significantly higher than that of control group of 30. 0% (P < 0. 05). During hospitalization,2 cases of control group and one case of observation group died,all caused by extensive anterior myocardial infarction and cardiogenic shock. The incidence of adverse clinical events during hospitalization of observation group was 13. 1% ,was statistically significantly lower than that of control group of 32. 5% ( P < 0. 05). Conclusion Preoperative oral ticagrelor can reduce the incidence of CSF during emergency PCI in patients with ASTEMI,without increasing the occurrence risk of adverse clinical events during hospitalization, and is safe.