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目的探讨替格瑞洛治疗急性ST段抬高型心肌梗死(ST-segment elevated myocardial infarction,STEMI)的临床效果及安全性。方法选取2013年1月—2014年7月收治的行经皮冠状动脉介入(percutaneous coronary intervention,PCI)的治疗154例STEMI患者作为研究对象,随机分为对照组76例和观察组78例。对照组患者给予阿司匹林+氯吡格雷治疗,观察组给予阿司匹林+替格瑞洛治疗。比较两组患者术后1.5 h ST段回落情况;术后1个月左室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、左室射血分数(left ventricular ejection fraction,LVEF);术中梗死相关动脉即刻心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)及不良心脏事件发生情况等。计量资料采用t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果观察组患者术后1.5 h ST段回落均值为(68.19±28.31)%,高于对照组的(50.33±24.62)%,差异有统计学意义(P<0.05)。观察组1.5 h ST段回落发生率为71.79%,高于对照组的44.74%,差异有统计学意义(P<0.05)。观察组患者术后1个月LVEF为(59.43±12.66)%,明显高于对照组的(52.68±3.09)%,差异有统计学意义(P<0.05)。观察组患者术中即刻TIMI、不良心脏事件发生率分别为92.31%、5.13%,均明显优于对照组的67.11%、17.11%,差异均有统计学意义(均P<0.05)。结论替格瑞洛用于行PCI治疗的STEMI,能有效改善心肌再灌注和预后,提高PCI术中即刻TIMI 3级血流发生率。
Objective To investigate the clinical efficacy and safety of ticagrelor in the treatment of acute ST-segment elevation myocardial infarction (STEMI). Methods From January 2013 to July 2014, 154 STEMI patients undergoing percutaneous coronary intervention (PCI) were randomly divided into control group (n = 76) and observation group (n = 78). Patients in the control group were treated with aspirin + clopidogrel, and those in the observation group were given aspirin plus ticagrelor. The fall of ST segment at 1.5 h postoperatively was compared between the two groups. The left ventricular end diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF) Related artery immediate myocardial thrombolysis test (thrombolysis in myocardial infarction, TIMI) and adverse cardiac events and so on. Measurement data using t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results In the observation group, the average ST-segment decline 1.5 h after operation was (68.19 ± 28.31)%, which was significantly higher than that of the control group (50.33 ± 24.62)% (P <0.05). The 1.5 h ST-segment depression rate in the observation group was 71.79%, which was higher than that in the control group (44.74%), the difference was statistically significant (P <0.05). The LVEF in observation group was (59.43 ± 12.66)% at one month after operation, which was significantly higher than that in control group (52.68 ± 3.09)%, the difference was statistically significant (P <0.05). The incidence of immediate TIMI and adverse cardiac events in the observation group was 92.31% and 5.13%, respectively, which were significantly better than those in the control group (67.11% and 17.11% respectively). The differences were statistically significant (both P <0.05). Conclusion STEMI, which is used in the treatment of PCI by ticagrelor, can effectively improve the myocardial reperfusion and prognosis and improve the incidence of immediate TIMI 3 blood flow during PCI.