替格瑞洛联合硝酸甘油治疗急性心肌梗死的临床研究

Clinical study of ticagrelor combined with nitroglycerin in treatment of acute myocardial infarction

目的探讨替格瑞洛联合硝酸甘油治疗急性心肌梗死的临床效果。方法选取2016年3月—2018年6月中国人民解放军第四军医大学第二附属医院收治的102例急性心肌梗死患者,随机分为对照组和治疗组,每组各51例。对照组静脉滴注硝酸甘油注射液,用输液泵以5μg/min恒速输入。治疗组患者在对照组治疗基础上口服替格瑞洛片,起始单次负荷剂量180 mg/d,而后维持剂量90 mg/次,2次/d。两组均连续治疗2周。观察两组的临床疗效,比较两组治疗前后左室射血分数(LVEF)、心肌梗死情况和血清学指标的变化情况。结果治疗后,对照组和治疗组的总有效率分别为80.4%和94.1%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组LVEF显著升高,但QRS积分、心肌梗死面积均较治疗前显著降低,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组LVEF高于对照组,但QRS积分、心肌梗死面积均显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组血清心肌肌钙蛋白(c Tn)T、肌酸激酶同工酶(CK-MB)、白介素(IL)-8、C反应蛋白(CRP)、血管内皮细胞蛋白C受体(EPCR)、血管性血友病因子(v WF)水平较治疗前均显著下降,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组cTnT、CK-MB、IL-8、CRP、EPCR、v WF水平显著低于对照组,两组比较差异具有统计学意义(P<0.05)。结论替格瑞洛联合硝酸甘油治疗急性心肌梗死具有较好的临床疗效,可缩小心肌梗死面积,减轻炎性损伤,保护心肌细胞和血管内皮细胞,具有一定的临床推广应用价值。

Objective To investigate the clinical effects of ticagrelor combined with nitroglycerin in treatment of acute myocardial infarction. Methods Patients（102 cases） with acute myocardial infarction in the Second Affiliated Hospital of the Fourth Military Medical University of the People’s Liberation Army from March 2016 to June 2018 were randomly divided into control（51 cases） and treatment（51 cases） groups. Patients in the control group were iv administered with Nitroglycerin Injection, and the infusion pump was input at a constant speed of 5 μg/min. Patients in the treatment group were po administered with Ticagrelor Tablets on the basis of the control group, started with a single dosage of 180 mg/d and then maintained at 90 mg/time, twice daily. Patients in two groups were treated for 2 weeks. After treatment, the clinical efficacy was evaluated, and the changes of LVEF, myocardial infarction and serologic indicators in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment group were 80.4% and 94.1%, and there were differences between two groups（P 〈 0.05）. After treatment, LVEF were significantly increased in two groups, but QRS score and myocardial infarction area were significantly decreased, and there were differences in the same group（P 〈 0.05）. After treatment, LVEF in the treatment group was higher than that in the control group, but QRS score and myocardial infarction area were lower than those in the control group, and there were differences between two groups（P 〈 0.05）. After treatment, cTnT, CK-MB, IL-8, CRP, EPCR, and vWF were significantly decreased, and there were differences in the same group（P 〈 0.05）. After treatment, cTnT, CK-MB, IL-8, CRP, EPCR, and vWF were lower than those in the control group, and there were differences between two groups（P 〈 0.05）. Conclusion Ticagrelor combined with nitroglycerin has significant clinical effect in treatment of acute myocardial infarction, and can shrink the myocardial infarction area, also can alleviate the inflammatory injury, and protect the myocardial cells and vascular endothelial cells, which has a certain clinical application value.