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目的:观察替格瑞洛对急性ST段抬高心肌梗死(STEMI)接受急诊冠状动脉介入治疗(PCI)患者的心肌保护作用。方法:连续入选住院的STEMI(发病12h内)并接受急诊PCI患者462例。根据患者应用不同P2Y12受体拮抗剂分为2组:替格瑞洛组在术前给予180mg负荷剂量,其后应用每日2次90mg维持剂量;氯吡格雷组在术前给予600mg负荷剂量,其后应用每日75mg维持剂量。比较2组心肌损伤程度,同时观察2种药物的安全性。结果:替格瑞洛组术后TIMI 3级血流比例(P=0.032)及术后ST段回落率(P=0.045)高于氯吡格雷组;而肌酸激酶同工酶(CK-MB)峰值(P=0.017)、肌钙蛋白Ⅰ(TnI)峰值(P=0.037)、肌酸激酶(CK)峰值(P=0.011)均显著低于氯吡格雷组,差异有统计学意义。2组术中无复流发生率虽无统计学差异,但替格瑞洛有降低术中无复流的趋势(P=0.061)。2组均无主要出血发生,轻微出血、小出血及不良事件发生率差异无统计学意义(P>0.05)。结论:替格瑞洛对急诊PCI术后的STEMI患者心肌具有保护作用,可以改善术后血流并减轻心肌损伤程度,且不增加出血的发生率,安全性高。
Objective: To observe the myocardial protective effect of ticagrelor in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). METHODS: A total of 462 STEMI patients (within 12 hours of onset) were enrolled and were enrolled in emergency PCI. According to patients with different P2Y12 receptor antagonists divided into two groups: ticagrelor group preoperatively given 180mg loading dose, then applied twice daily 90mg maintenance dose; clopidogrel group preoperative 600mg loading dose, Subsequent application of 75 mg daily maintenance dose. The degree of myocardial injury was compared between the two groups, while the safety of the two drugs was observed. Results: The TIMI grade 3 blood flow ratio (P = 0.032) and postoperative ST segment resolution (P = 0.045) were higher in the ticagrelor group than those in the clopidogrel group. The creatine kinase MB (P = 0.017), peak TnI (P = 0.037) and creatine kinase (CK) peak (P = 0.011) were significantly lower than those of clopidogrel group. The difference was statistically significant. There was no statistical difference in the incidence of no-reflow between the two groups, but there was a trend toward reducing the no-reflow during ticagrelor (P = 0.061). No major bleeding occurred in both groups. There was no significant difference in the incidences of mild bleeding, small bleeding and adverse events (P> 0.05). CONCLUSION: Ticagrelor has protective effect on myocardium of STEMI patients after emergency PCI, which can improve postoperative blood flow and reduce the degree of myocardial injury without increasing the incidence of bleeding and high safety.