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目的:观察急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介人治疗(PCI)术前应用大负荷量氯吡格雷对术后心肌微循环灌注及心脏功能的影响。方法:64例成功接受急诊PCI的STEMI患者随机分为氯吡格雷300 mg组和600 mg组。比较两组间的基础临床状况和造影情况、结果以及术后心肌呈色显像(Blush)3级获得率、ST抬高总和回落百分比(sumSTR%)、心功能以及胎盘生长因子(PIGF)、可溶性CD40配体(sCD40L)的变化。结果:术后氯吡格雷600 mg组的Blush 3级获得率明显高于300 mg组(50.0%∶21.88%,P<0.05),ST段抬高总和回落百分比显著下降[(70.90±9.51)∶(60.70±15.06)%,P<0.05],左室射血分数(LVEF%)明显增加[(70.96±9.51)∶(65.27±9.85)%,P<0.05],PIGF较300 mg组显著下降[(14.37±1.32)∶(15.85±1.71)ng/L,P<0.05],sCD40L较300 mg组显著下降[(4.93±0.71)∶(5.68±0.77)μg/L,P<0.05]。结论:急性ST段抬高型心肌梗死患者急诊PCI术前给予超负荷量氯吡格雷可以改善PCI术后的心肌微循环灌注,改善心功能状况。
Objective: To observe the effects of preoperative application of high-dose clopidogrel on myocardial perfusion and cardiac function after acute percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction. Methods: Sixty-four STEMI patients who were successfully treated with PCI were randomly divided into clopidogrel 300 mg and 600 mg groups. Baseline clinical status and radiography were compared between the two groups. The results were compared with Blush grade 3, sumSTR%, heart function and placental growth factor (PIGF) Changes in soluble CD40 ligand (sCD40L). Results: The postoperative Blush 3 grade of clopidogrel 600 mg group was significantly higher than that of the 300 mg group (50.0% vs 21.88%, P <0.05), and the percentage decline of the sum of ST segment elevation was significantly lower (70.90 ± 9.51) (P <0.05). The PVEF decreased significantly compared with the control group (P <0.05), and the LVEF% significantly increased (70.96 ± 9.51% vs 65.27 ± 9.85%, P <0.05) (14.37 ± 1.32) vs (15.85 ± 1.71) ng / L, P <0.05]. The sCD40L level was significantly lower than that of the 300 mg group (4.93 ± 0.71 vs 5.68 ± 0.77 μg / L, P <0.05). Conclusion: Patients with acute ST-segment elevation myocardial infarction who received emergency PCI before clopidogrel can improve myocardial perfusion after PCI and improve cardiac function.