替格瑞洛在急性心肌梗死溶栓后择期冠状动脉介入治疗的临床研究

Clinical trial of ticagrelor in the treatment of acute myocardial infarction in patients with percutaneous coronary intervention after thrombolytic therapy

目的 观察替格瑞洛和氯吡格雷对急性心肌梗死溶栓后择期经皮冠状动脉介入治疗（PCI）患者的临床疗效与安全性。方法 将130例急性ST段抬高型心肌梗死患者随机分为对照组64例和试验组66例。对照组予以口服氯吡格雷首次剂量300 mg,维持剂量75 mg,qd;试验组予以口服替格瑞洛首次剂量180mg,维持剂量90 mg,bid。2组患者均在起病8~12 d成功接受PCI手术。比较2组患者的术后心肌梗死溶栓治疗临床试验（TIMI）血流分级、术前和术后左心室射血分数（LVEF）和左心室舒张末期内径（LVEDD）,术后无复流/慢血流及出血事件的发生率。结果 术后,试验组的TIMI血流分级及LVEF均显著高于对照组（P〈0.01）,试验组的LVEDD低于对照组（P〈0.01）。术后,试验组的无复流/慢血流发生率为3.03%显著低于对照组的14.06%（P〈0.05）。2组患者均只发生轻微出血事件,但术后6个月出血事件发生率比较差异无统计学意义（P〉0.05）。结论 替格瑞洛在急性心肌梗死溶栓后择期PCI手术中有较好的临床疗效,可显著改善患者术后TIMI血流,有更强的抗血小板聚集功能,且不增加出血事件的发生率。

Objective To compare the clinical efficacy and safety of ti- cagrelor and clopidogrelin the treatment of acute myocardial infarction in patients with percutaneous coronary intervention （PCI） after thrombolytic therapy. Methods A total of 130 ST - segment myocardial infarction （STEM） patients were randomly divided into control group（ n = 64） and treatment group （n = 66 ）. The patients of control group were given clopi- dogrel 300 rag, maintenance dose 75 mg qd. The patients of treatment group were given ticagrelor 180 mg, maintenance dose 90 mg bid. All the patients of two groups received selective PCI successfully after 8 - 10 d treatment. The change of thrombolysis in myocardial infarction （TIMI） flow grades after operation, left ventricular ejection fraction （LVEF） and left ventricular end - diastolic dimension （ LVEDD ）, the incidence of no- reflow/slow flow and adverse drug reactions after operation were compared between two groups. Results After operation, the TIMI flow grades and LVEF in treatment group were significantly higher than those in control group （P 〈0. 01）. After operation, the LVEDD in treatment group was lower than that in control group, with significant difference （P 〈0. 01 ）. respectively, happened in （P 〉0.05）. thrombolytic the two groups, there was no statistically significant difference in two groups after operation 6 months Conclusion Ticagrelor could support better clinical efficacy than clopidogre in selective PCI after therapy for acute myocardial infarction, which has a stronger anti -platelet aggregation function without increasing the incidence of bleeding events.