摘要
目的探讨急性ST段抬高型心肌梗死并缓慢性心律失常患者行急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)时应用替格瑞洛的临床效果。方法急性ST段抬高型心肌梗死并缓慢性心律失常患者103例,随机分为替格瑞洛组51例和氯吡格雷组52例,2组均于发病12h内行急诊PCI术。替格瑞洛组PCI术前口服替格瑞洛180mg、阿司匹林300mg;术后口服替格瑞洛90mg/次,2次/d,阿司匹林100mg/次,1次/d。氯吡格雷组术前口服氯吡格雷300~600mg、阿司匹林300mg,术后口服氯吡格雷75mg/次,阿司匹林100mg/次,均1次/d。比较2组住院期间心血管事件发生情况;记录2组住院时间,因缓慢性心律失常应用临时起搏器、永久起搏器、阿托品、多巴胺比率,住院期间心肌肌钙蛋白I(cardiac troponin I,cTnI)峰值和肌酸激酶同工酶(creatine kinase isoenzyme MB,CK-MB)峰值,出院时B型脑钠肽(B-type natriuretic peptide,BNP)、左室射血分数(left ventricular ejection fraction,LVEF),及缓慢性心律失常发生情况。结果替格瑞洛组和氯吡格雷组罪犯血管比率比较差异无统计学意义(P>0.05);替格瑞洛组住院期间心血管事件发生率(9.80%)与氯吡格雷组(13.46%)比较差异无统计学意义(P>0.05);替格瑞洛组住院时间[(7.06±2.07)d],应用临时起搏器(29.41%)、永久起搏器(0)、阿托品(19.61%)、多巴胺比率(27.45%),住院期间cTnI峰值[(18.86±12.77)μg/L]、CK-MB峰值[(190.87±71.69)u/L],出院时BNP[(879.60±117.33)ng/L]、LVEF[(52.79±12.01)%]及出院时窦性心动过缓、Ⅱ°房室传导阻滞、Ⅲ°房室传导阻滞发生率(3.92%、1.96%、0)与氯吡格雷组[(6.93±2.29)d、30.77%、1.92%、19.23%、26.92%、(894.13±105.98)ng/L、(18.25±12.09)μg/L、(182.54±66.81)u/L、(52.11±12.82)%、3.85%、0、1.92%]比较差异均无统计学意义(P>0.05)。结论急性ST段抬高型心肌梗死并缓慢性心律失常患者行急诊PCI术前、术后应用替格瑞洛或氯吡格雷均可取得较好疗效。
Objective To observe the clinical effect of ticagrelor on acute ST-segment elevation myocardial infarction （STEMI） and bradyarrhythmia during primary percutaneous coronary intervention （PCI）. Methods Totally 103 patients with acute STEMI and bradyarrhythmia were randomly divided into ticagrelor group （n： 5l） and clopidogrel group （n= 52）. Both group received primary PCI in 12 h after attack. Ticagrelor group received oral administration of 180 mg of tieagrelor and 300 mg of aspirin before primary PCI, followed by 90 mg of ticagrelor and 100 mg of aspirin twice a day after PCI. Clopidogrel group received oral administration of 300 to 600 mg of clopidogrel and 300 mg of aspirin before primary PCI, followed by 75 mg of elopidogrel and 100 mg of aspirin once a day. The in-hospital cardiovascular events were compared between two groups. The hospitalization stay, as well as the proportions of using temporary pacemaker, permanent pacemaker, atropine and dopamine due to bradyarrhythmia were recorded. The peak value of cardiac troponin I （eTnI） and creatine kinase isoenzyme MB （CK-MB） during hospitalization, B-type natriuretic peptide （BNP） and left ventrieular ejection fraction （LVEF） at discharge, and the occurrence of bradyarrhythmia at discharge were observed. Results There were no significant differences in the proportion of culprit vessels, the incidence of cardiovascular events （9.80% vs 13.4%）, hospitalization stay （（7.06 ＋ 2.07） d vs （6. 93 ± 2. 29） d）, the proportions of using temporary pacemaker （29.41% vs 30.77%）, permanent pacemaker （0 vs 1.92%）, atropine （19.61% vs 19.23o/6） and dopamine （27.45% vs 26.92%） during hospitalization, peak values of cTnI （（18.86±12.77） μg/L vs （18.25-112.09） μg/L） and CK-MB （（190.87±71.69） u/L vs （182.54±66.81） u/L） during hospitalization, the levels of BNP （（879.60±117.33） ng/L vs （894. 13±105. 98） ng/L） and LVEF （（52. 79±12. 01）% vs （52. 11±12. 82）%） at discharge, and the incidences of tachycardia （3.92% vs 3.85%）, the second degree atrioventricular block （1.96% vs 0） and the third degree atrioventricular block （0 vs 1.92 %） at discharge between ticagrelor group and clopidogrel group （P〉0.05）. Conclusion Both ticagrelor and clopidogrel before and after primary PCI can achieve good curative effects on patients with acute STEMI complicated with bradyarrhythmia.
作者
马登峰
裴志强
李炳蔚
武利军
王晨
穆景博
党振騠
苏鑫
白静
张书毓
邱金
MA Deng-feng , PEI Zhi-qiang, LI Bing wei, WU Li-jun, WANG Chen, MU Jing bo, DANG Zhen-ti, SU Xin, BAI Jing, ZHANG Shu-yu, OIU Jin(Department of Cardiology, Taiyuan Central Hospital, Taiyuan Cardiovascular Research Institute, Taiyuan 030009, Chin)
出处
《中华实用诊断与治疗杂志》
2018年第3期275-278,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
山西省科技攻关项目基金(20140313015-17)
太原市中心医院院士工作站基金(2015.12)
