替格瑞洛配合经皮冠状动脉介入治疗在急性心肌梗死患者中的应用

The Application of Ticagrelor Combined with Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction

目的:探究替格瑞洛配合经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者心功能、血管内皮功能指标的影响。方法:选取2021年1月—2023年1月宜春市第二人民医院心内科收治的102例接受PCI的AMI患者作为研究对象,按照随机数字表法分为对照组、观察组,各51例,在常规治疗及PCI基础上,对照组接受阿司匹林肠溶片+硫酸氢氯吡格雷片治疗,观察组接受阿司匹林肠溶片+替格瑞洛片治疗。比较两组患者心功能[左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)及左心室射血分数(left ventricular ejection fraction,LVEF)]、血管内皮功能[内皮素-1(endothelin-1,ET-1)、一氧化氮(nitric oxide,NO)、前列环素I2(prostacyclin,PGI2)、血栓烷B2(thromboxane B2,TXB2)]、血清心肌标志物[肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、心肌肌钙蛋白I(cardiac troponin I,cTnI)、N末端脑钠肽前体(N-terminal pro brain natriuretic peptide,NT-proBNP)]水平及主要不良心血管事件(MACE)发生情况。结果:治疗后,两组的LVEDD、LVESD均低于治疗前,LVEF均高于治疗前,且观察组的LVEDD、LVESD均低于对照组,LVEF高于对照组(P<0.05)。治疗后,两组的ET-1、TXB2均低于治疗前,NO、PGI2均高于治疗前,且观察组的ET-1、TXB2均低于对照组,NO、PGI2均高于对照组(P<0.05)。治疗后,两组的CK-MB、cTnI、NT-proBNP均低于治疗前,且观察组的CK-MB、cTnI、NT-proBNP均低于对照组(P<0.05)。观察组的MACE发生率低于对照组(P<0.05)。结论:替格瑞洛配合PCI可以显著改善AMI患者的心功能和血管内皮功能,降低心肌损伤指标和MACE的发生风险。

Objective:To explore the effects of Ticagrelor combined with percutaneous coronary intervention(PCI)on cardiac function and vascular endothelial function in patients with acute myocardial infarction(AMI).Method:A total of 102 AMI patients undergoing PCI admitted to the Department of Cardiology of Yichun Second People's Hospital from January 2021 to January 2023 were selected as the study objects,and were divided into control group and observation group according to random number table method,with 51 cases in each group.On the basis of routine treatment and PCI,the control group received Aspirin Enteric-coated Tablets+Clopidogrel Hydrogen Sulphate Tablets,and the observation group received Aspirin Enteric-coated Tablets+Ticagrelor Tablets.Cardiac function[left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)],vascular endothelial function[endothelin-1(ET-1),nitric oxide(NO),prostacycline I2(PGI2),thromboxane B2(TXB2)]and serum myocardial markers[creatine kinase isoenzyme(CKMB),cardiac troponin I(cTnI),N-terminal brain natriuretic peptide precursor(NT-proBNP)]levels and major adverse cardiovascular events(MACE)were compared between the two groups.Result:After treatment,LVEDD and LVESD in both groups were lower than those before treatment,and LVEF were higher than those before treatment,LVEDD and LVESD in the observation group were lower than those in the control group,while LVEF was higher than that in the control group(P<0.05).After treatment,ET-1 and TXB2 in both groups were lower than those before treatment,while NO and PGI2 were higher than those before treatment,ET-1 and TXB2 in the observation group were lower than those in the control group,and NO and PGI2 were higher than those in the control group(P<0.05).After treatment,CK-MB,cTnI,and NT-proBNP in both groups were lower than those before treatment,and the levels of CK-MB,cTnI,and NT-proBNP in the observation group were lower than those in the control group(P<0.05).The incidence of MACE in the observation group was lower than that in the control group(P<0.05).Conclusion:Ticagrelor combined with PCI can significantly improve cardiac function and vascular endothelial function in patients with AMI,and reduce myocardial injury indicators and the risk of MACE.