[關(guān)鍵詞]
[摘要]
目的 探討替格瑞洛聯(lián)合阿托伐他汀和阿司匹林對急性ST段抬高型心肌梗死(STEMI)經(jīng)皮冠狀動脈介入術(shù)(PCI)術(shù)后心肌血流灌注的影響,為其臨床診治提供參考。方法 選擇2015年5月-2019年3月鄭州市第一人民醫(yī)院收治的100例行PCI手術(shù)的STEMI的患者作為研究對象,按照治療方法將患者分為對照組和觀察組,各50例。對照組口服阿托伐他汀鈣片,20 mg/次,1次/d;阿司匹林腸溶片,100 mg/次,1次/d。觀察組患者在對照組治療基礎(chǔ)上口服替格瑞洛片,180 mg/次為初始劑量,之后90 mg/次,2次/d。共治療2個月,隨訪半年。比較兩組患者PCI術(shù)后即刻冠狀動脈血流及心肌血流灌注指標(biāo),分析兩組患者住院期間及隨訪6個月的心功能指標(biāo)及主要不良心血管事件(MACE)。比較兩組患者治療前后血清心肌肌鈣蛋白I(cTnI)、血管性血友病因子(vWF)、肌酸激酶同工酶(CK-MB)及血管內(nèi)皮生長因子(VEGF)水平變化。結(jié)果 治療后,觀察組患者PCI術(shù)后ST段回落率、TIMI血流分級3級以及TMPG3級患者均明顯高于對照組,而cTFC值比對照組降低(P<0.05)。兩組患者治療后LVEF、E/A明顯升高,LVEDD明顯降低(P<0.05);且觀察組患者治療后上述指標(biāo)改善更為顯著(P<0.05)。治療后,兩組患者的血清CK-MB水平明顯降低,血清VEGF、vWF及cTnI水平均明顯升高(P<0.05)。治療后,觀察組患者CK-MB水平顯著低于對照組,VEGF、vWF和cTnI水平顯著高于對照組(P<0.05)。觀察組住院期間及術(shù)后隨訪MACE發(fā)生率低于對照組(P<0.05)。結(jié)論 替格瑞洛聯(lián)合阿托伐他汀和阿司匹林可以更好改善PCI術(shù)后STEMI患者的凝血纖溶系統(tǒng)和心肌血流灌注,保護(hù)心功能,減少預(yù)后MACE事件的發(fā)生率,具有一定的臨床應(yīng)用價值。
[Key word]
[Abstract]
Objective To explore the effect of ticagrelor combined with atorvastatin and aspirin on myocardial blood perfusion after PCI in acute ST-segment elevation myocardial infarction (STEMI), and provide a reference for its clinical diagnosis and treatment. Methods A total of 100 STEMI patients who underwent PCI surgery in Zhengzhou First People's Hospital from May 2015 to March 2019 were selected as the research subjects. According to the treatment methods, the patients were divided into control group and observation group, with 50 cases in each group. Patients in the control group were po administered with Atorvastatin Calcium Tablets, 20 mg/time, once daily, and Aspirin Enteric-coated Tablets, 100 mg/time, once daily. Patients in the observation group were po administered with Ticagrelor Tablets on the basis of control group,180 mg/time as the initial dose, followed by 90 mg/time, twice daily. The patients were treated for two months and followed up for six months. The indexes of coronary blood flow and myocardial blood perfusion immediately after PCI were compared between two groups, and the indexes of cardiac function and major adverse cardiovascular events (MACE) during hospitalization and 6 months follow-up were analyzed. The serum levels of cTnI, vWF, CK-MB, and VEGF were compared before and after treatment between two groups. Results After treatment, the ST segment pullback rate, TIMI grade 3 and TMPG3 patients in observation group were significantly higher than those in control group, while the cTFC value was lower than that in control group (P<0.05). After treatment, LVEF and E/A in two groups were significantly increased, while LVEDD was significantly decreased (P<0.05). The above indexes in the observation group were improved more significantly after treatment (P<0.05). After treatment, the serum CK-MB level in two groups was significantly decreased, while the serum VEGF, vWF and cTnI levels were significantly increased (P<0.05). After treatment, the level of CK-MB in observation group was significantly lower than control group, and the levels of VEGF, vWF and cTnI in observation group were significantly higher than control group (P<0.05). The incidence of MACE during hospitalization and postoperative follow-up in observation group was lower than that in control group (P<0.05). Conclusion Tagrelor combined with atorvastatin and aspirin can better improve the coagulation and fibrinolysis system and myocardial blood perfusion in STEMI patients after PCI, protect cardiac function and reduce the incidence of prognostic MACE events, which has certain clinical application value.
[中圖分類號]
R972
[基金項目]
河南省醫(yī)學(xué)科技攻關(guān)計劃(聯(lián)合共建)項目(LHGJ20190991)