替格瑞洛在氯吡格雷抵抗急性心肌梗死患者PCI术后抗血小板治疗中的应用价值

The Applicative Value of Ticagrelor in Clopidogrel resistance of PCI postoperative Antiplatelet therapy in Patients with Acute Myocardial Infarction

目的:观察替格瑞洛在氯吡格雷抵抗急性心肌梗死(AMI)患者行经皮冠状动脉介入治疗(PCI)术后抗血小板治疗中的效果,并评价其临床应用价值。方法:将符合氯吡格雷抵抗标准的96例AMI患者随机分为两组,对照组(n=48)PCI术前加服氯吡格雷负荷剂量,术后以高剂量维持,观察组术前加服替格瑞洛,术后常规剂量维持,比较两组患者术后的血小板聚集率、肝肾功能、不良反应以及随访主要不良心脑血管事件(MACCE)发生情况。结果:观察组术后2h、24h、7d的血小板聚集率均显著低于对照组(P<0.05);两组术后的AST、血肌酐水平、不良反应率的差异均有统计学意义(P<0.05);观察组随访半年的MACCE发生率低于对照组(P<0.05)。结论:替格瑞洛治疗符合氯吡格雷抵抗标准的AMI疗效确切,能够降低血小板聚集率和不良反应率,减少肝功损伤与MACCE发生风险,临床应用价值较高。

Objective： To observe the effect of ticagrelor in clopidogrel resistance of PCI postoperative antiplatelet therapy in patients with acute myocardial infarction,and to evaluate its clinical application value.Method： According to the clopidogrel resistance standard,96 cases with AMI were randomly divided into 2groups,observation group and control group The patients in control group took clopidogrel loading dose before PCI operation,and maintained high dose after surgery in each group with 48 cases while those in observation group,the were given ticagrelor before operation and kept the conventional dose after that,the comparisons were made about postoperative platelet aggregation rate,liver and kidney function,adverse reactions and follow-up of MACCE happening. Result： The platelet aggregation rates at 2h,24 h and 2d aftersurgery in observation group were significantly lower than those in control group（ P〈0. 05）; the AST,serum creatinine levels,and the rate of adverse reaction after sungery were greatly different between the two group（ P〈0. 05）;After half a year of follow-up,the MACCE occurence rate in observation group was lower than that in control group（ P〈0. 05）. Conclusion： Ticagrelor showed exact curative effect for the patients with standard of Clopidogrel resistance of AMI decreased the rate of platelet aggregation rate and adverse reaction and,reduced the risk of liver damage and MACCE,It gave higher clinical value.