CAJ | 학술논문

目的观察替格瑞洛在老年急性ST段抬高心肌梗死(ST elevation myocardial infarction,STEMI)患者急诊经皮冠状动脉介入治疗(percutanous coronary intervention,PCI)术中的效果及安全性.方法 125例行急诊PCI的老年(年龄＞60岁)STEMI患者,随机分为替格瑞洛组62例和对照组63例,替格瑞洛组术前给予替格瑞洛180 mg、阿司匹林300mg嚼服,对照组术前给予氯吡格雷600mg、阿司匹林300 mg嚼服,冠状动脉造影后2组均以5 μg/kg的小剂量冠状动脉内注射替罗非班,对比分析2组PCI术后梗死相关动脉心肌梗死溶栓治疗(thrombolysis in myocardial infarction,TIMI)血流分级,校正的TIMI计祯数(corrected TIMI frame counts,CTFC)及TIMI心肌灌注(TIMI myocardial perfusion,TMP)分级,PCI术后1周心功能,PCI术后30 d主要不良心脏事件(major adverse cardiac events,MACE)及出血并发症.结果替格瑞洛组PCI术后梗死相关动脉TIMI 3级比例高于对照组(91.9％ vs 79.4％,P＜0.05),CTFC低于对照组(22.67土5.14 vs 31.36±4.72,P＜0.01),TMP 2级以上比例高于对照组(77.4％vs 60.3％,P＜0.05);PCI术后1周替格瑞洛组左心室射血分数高于对照组(P＜0.01);2组出血并发症差异无统计学意义;PCI术后30 d替格瑞洛组MACE发生率低于对照组(6.5％vs 19.1％,P＜0.05).结论老年STEMI患者急诊PCI术前应用替格瑞洛联合替罗非班可以迅速抑制血小板聚集,增加梗死相关动脉TIMI血流分级,改善心肌灌注,减少无复流发生,而且不增加出血并发症发生率,可减少MACE事件发生.
목적 관찰체격서락재노년급성ST단태고심기경사(ST elevation myocardial infarction,STEMI)환자급진경피관상동맥개입치료(percutanous coronary intervention,PCI)술중적효과급안전성.방법 125례행급진PCI적노년(년령＞60세)STEMI환자,수궤분위체격서락조62례화대조조63례,체격서락조술전급여체격서락180 mg、아사필림300mg작복,대조조술전급여록필격뢰600mg、아사필림300 mg작복,관상동맥조영후2조균이5 μg/kg적소제량관상동맥내주사체라비반,대비분석2조PCI술후경사상관동맥심기경사용전치료(thrombolysis in myocardial infarction,TIMI)혈류분급,교정적TIMI계정수(corrected TIMI frame counts,CTFC)급TIMI심기관주(TIMI myocardial perfusion,TMP)분급,PCI술후1주심공능,PCI술후30 d주요불양심장사건(major adverse cardiac events,MACE)급출혈병발증.결과 체격서락조PCI술후경사상관동맥TIMI 3급비례고우대조조(91.9％ vs 79.4％,P＜0.05),CTFC저우대조조(22.67토5.14 vs 31.36±4.72,P＜0.01),TMP 2급이상비례고우대조조(77.4％vs 60.3％,P＜0.05);PCI술후1주체격서락조좌심실사혈분수고우대조조(P＜0.01);2조출혈병발증차이무통계학의의;PCI술후30 d체격서락조MACE발생솔저우대조조(6.5％vs 19.1％,P＜0.05).결론 노년STEMI환자급진PCI술전응용체격서락연합체라비반가이신속억제혈소판취집,증가경사상관동맥TIMI혈류분급,개선심기관주,감소무복류발생,이차불증가출혈병발증발생솔,가감소MACE사건발생.