摘要
目的探讨替格瑞洛联合小剂量替罗非班对行急诊经皮冠状动脉介入术(PCI)老年急性ST段抬高型心肌梗死(STEMI)患者梗死相关动脉(IRA)血流及主要不良心血管事件(MACE)的影响。方法选择2016年3月至2017年3月在北京市垂杨柳医院心脏中心确诊为STEMI并行急诊PCI的老年患者105例为研究对象,根据治疗方法将患者分为观察组(n=50)和对照组(n=55)。2组患者均行PCI,术前均给予负荷量阿司匹林300 mg及替格瑞洛180 mg,嚼服;在此基础上,观察组患者经导管冠状动脉内注射替罗非班5μg·kg^(-1),术后继续给予替罗非班0.07μg·kg^(-1)·min^(-1)静脉泵入36 h;对照组患者经导管冠状动脉内注射替罗非班10μg·kg^(-1),术后继续给予替罗非班0.15μg·kg^(-1)·min^(-1)静脉泵入36 h。观察2组患者PCI术中IRA无复流或慢血流、6个月内MACE及出血等不良反应情况。结果对照组患者PCI术中IRA无复流和慢复流的发生率均为3.6%(2/55),观察组患者PCI术中IRA无复流和慢复流的发生率均为2.0%(1/50),2组患者PCI术中IRA无复流和慢复流的发生率比较差异无统计学意义(χ2=0.090、0.090,P>0.05)。对照组和观察组患者MACE发生率分别为23.6%(13/55)和10.0%(5/50),2组患者MACE发生率比较差异无统计学意义(χ2=3.429,P>0.05)。对照组和观察组患者轻度出血发生率分别为16.4%(9/55)、4.0%(2/50),观察组患者轻度出血发生率低于对照组(χ2=4.269,P<0.05)。对照组和观察组患者Ⅰ度血小板减少发生率分别为9.1%(5/55)、4.0%(2/50),2组患者均未出现Ⅱ度以上的血小板减少;对照组和观察组患者非心源性呼吸困难发生率分别为3.6%(2/55)、6.0%(3/59);2组患者血小板减少和非心源性呼吸困难发生率比较差异均无统计学意义(χ2=0.426、0.012,P>0.05)。结论替格瑞洛联合小剂量替罗非班可有效改善行急诊PCI老年STEMI患者的IRA血流,且出血风险低,不良反应轻。
Objective To investigate the effect of ticagrelor combined with low dose tlrofiban on infarction related artery(IRA)blood flow and major adverse cardiovascular events(MACE)in elderly patients with acute ST-segment elevated myocardial infarction(STEMI)undergoing emergency percutaneous coronary intervention(PCI).Methods One hundred and five elderly STEMI patients who underwent emergency PCI in Department of Heart Center,Chuiyangliu Hospital of Beijing from March 2016 to March 2017 were selected as the study subjects.All patients were divided into control group(n=55)and observation group(n=50)according to the treatment method.All patients were given PCI.Before the PCI,all patients were given aspirin 300 mg and ticagrelor 180 mg for chewing.Based on this,the low dose of tirofiban(5μg·kg-1)was injected into the coronary artery by catheter in the patients of observation group,and the low dose of tirofiban(0.07μg·kg-1·min-1)was continued to give by intravenous continuous pumping for 36 h after PCI;the routine dose of tiropin(10μg·kg-1)was injected into the coronary artery by catheter in the patients of control group,and the routine dose of tiropin(0.15μg·kg-1·min-1)was continued to give by intravenous continuous pumping for 36 h after PCI.The incidence of no reflow and slow blood flow during PCI,the MACE in 6 months after discharge from hospital and adverse reactions were observed in the two groups.Results The incidence of no reflow during PCI of patients in the control group and observation group was 3.6%(2/55)and 2.0%(1/50),the incidence of slow blood flow during PCI of patients in the control group and observation group was 3.6%(2/55)and 2.0%(1/50);there was no statistic difference in the incidence of no reflow and slow blood flow during PCI between the two groups(χ2=0.900,0.090;P>0.05).The incidence of MACE of patients in the control group and observation group was 23.6%(13/55)and 10.0%(5/50)respectively;there was no statistic difference in the incidence of MACE between the two groups(χ2=3.429,P>0.05).No major bleeding were found in the both groups.The incidence of slight bleeding in the control group and observation group was 16.4%(9/55)and 4.0%(2/50)respectively;the incidence of bleeding in the observation group was significanlty lower than that in the control group(χ2=4.269,P<0.05).There was no above degreeⅡthrombocytopenia in the two groups.The incidence of degreeⅠthrombocytopenia in the control group and observation group was 9.1%(5/55)and 4.0%(2/50)respectively;the incidence of non cardiac dyspneain the control group and observation group was 3.6%(2/55)and 6.0%(3/50)respectively;there was no statistic difference in the incidence of degreeⅠthrombocytopenia and non cardiac dyspnea between the two groups(χ2=0.426,0.012;P>0.05).Conclusion Ticagrelor combined with low dose tyropiban can effectively improve the IRA blood flow in elderly STEMI patients who undergo emergency PCI and with low bleeding risk and mild adverse reactions.
作者
詹小娜
包恩泽
李贵华
王亚娟
高蕾
富丽娟
ZHAN Xiao-na;BAO En-ze;LI Gui-hua;WANG Ya-juan;GAO Lei;FU Li-juan(Department of Heart Center,Chuiyangliu Hospital of Beijing,Beijing 100022,China)
出处
《新乡医学院学报》
CAS
2018年第7期584-587,共4页
Journal of Xinxiang Medical University
基金
北京市朝阳区科技计划项目(编号:CYSF151601)
