目的 探討術(shù)前負(fù)荷量替格瑞洛對(duì)改善急性心肌梗死患者經(jīng)皮冠脈介入（PCI）術(shù)后心肌灌注的作用。方法 選取2015年6月-2016年6月焦作市人民醫(yī)院收治的PCI術(shù)后急性心肌梗死患者120例，隨機(jī)分為對(duì)照組（60例）和治療組（60例）。兩組患者于PCI術(shù)前30 min嚼服阿司匹林片，0.3 g/次，對(duì)照組在此基礎(chǔ)上嚼服硫酸氫氯吡格雷片，600 mg/次，治療組在阿司匹林片基礎(chǔ)上嚼服替格瑞洛片，180 mg/次。兩組患者均于術(shù)中動(dòng)脈鞘推注低分子肝素鈉注射液1 000 U/kg，同時(shí)靜脈持續(xù)泵入鹽酸替羅非班注射液10 μg/L，持續(xù)24~36 h。兩組患者PCI術(shù)1周后均長期皮下注射低分子肝素鈉注射液5 000 U/次，對(duì)照組患者在此基礎(chǔ)上長期口服阿司匹林片100 mg/d聯(lián)合硫酸氫氯吡格雷片75 mg/d，治療組在此基礎(chǔ)上長期口服阿司匹林片100 mg/d聯(lián)合替格瑞洛片90 mg/d。比較PCI前后兩組患者心肌血流灌注指標(biāo)、超聲心動(dòng)圖指標(biāo)、血清單核細(xì)胞趨化因子1（MCP-1）和高遷移率族蛋白1（HMGB1）水平以及主要心臟不良事件（MACE）發(fā)生率和不良反應(yīng)率。結(jié)果 PCI術(shù)后，治療組TIMI 3級(jí)57例、TMPG 3級(jí)54例，分別明顯多于對(duì)照組的42例和40例，且治療組無復(fù)流/慢血流比例顯著低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。PCI術(shù)后，治療組患者左室后壁厚度（LVPWT）、室間隔厚度（IVST）、左室舒張末內(nèi)徑（LVDd）水平明顯降低，左心室射血分?jǐn)?shù)（LVEF）水平升高，同組PCI術(shù)前后比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）；且PCI術(shù)后治療組超聲心動(dòng)圖指標(biāo)明顯優(yōu)于對(duì)照組（P<0.05）。PCI術(shù)后，兩組患者血清MCP-1、HMGB1水平均顯著降低（P<0.05）；且治療組上述血清MCP-1、HMGB1水平明顯低于對(duì)照組（P<0.05）。治療組隨訪期間MACE發(fā)生率顯著低于對(duì)照組，且治療組MACE總發(fā)生率和不良反應(yīng)總發(fā)生率明顯低于對(duì)照組，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 術(shù)前負(fù)荷應(yīng)用替格瑞洛抗栓治療能有效改善急性心肌梗死患者PCI術(shù)后心肌灌注及心功能，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the effect of loading ticagrelor in treatment of myocardial perfusion of patients with acute myocardial infarction after PCI. Methods Patients (120 cases) with acute myocardial infarction after PCI in Jiaozuo People's Hospital from June 2015 to June 2016 were randomly divided into control (60 cases) and treatment (60 cases) groups. Patients in two groups were chewing administered with Aspirin Tablets 30 min before PCI. Patients in the control group were chewing administered with Clopidogrel Bisulfate Tablets based on Aspirin Tablets, 600 mg/time, patients in the treatment group were chewing administered with Ticagrelor Tablets on the basis of Aspirin Tablets, 180 mg/time. Patients in two groups were arterial sheath injection administered with Low Molecular Weight Heparin Sodium Injection in the surgery by 1 000 U/kg, at the same time they were continuous intravenous infusion administered with Tirofiban Hydrochloride Injection 10 μg/L for 24-36 h. Patients in two groups were long-term subcutaneous injection administered with Low Molecular Weight Heparin Sodium Injection 1 weeks after PCI, 5 000 U/time. on this basis, patients in the control group were long-term po administered with Aspirin Tablets by 100 mg/d and Clopidogrel Bisulfate Tablets by 75 mg/d. Patients in the treatment group were long-term po administered with Aspirin Tablets by 100 mg/d and Ticagrelor Tablets by 90 mg/d. Myocardial perfusion indexes, echocardiographic indicators, MCP-1 and HMGB1 levels, incidence of MACE and adverse reaction in two groups before and after PCI were compared. Results After PCI, TIMI grade 3 in the treatment group were 57 cases, TMPG grade 3 were 54 cases, which were significantly more than 42 cases and 40 cases in the control group, respectively, and the no reflow/slow flow in the treatment group was significantly lower than that in the control group, and there were differences between two groups (P<0.05). After PCI, the LVPWT, IVST and LVDd levels in two groups were significantly decreased, but the LVEF was significantly increased, and the difference was statistically significant in the same group (P<0.05). And the echocardiographic indicators in the treatment group were significantly better than those in the control group (P<0.05). After PCI, the MCP-1 and HMGB1 levels in two groups were significantly decreased (P<0.05). And the MCP-1 and HMGB1 in the treatment group was significantly lower than that in the control group (P<0.05). During follow-up, the incidence of MACE in the treatment group was significantly lower than that in the control group (P<0.05), and the total incidence of MACE and adverse reaction in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Picagrelor can effectively improve myocardial perfusion and cardiac function in treatment of patients with acute myocardial infarction after PCI, which has a certain clinical application value.