替格瑞洛和氯吡格雷对老年急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后并发症及预后的影响

doi:10.3969/j.issn.1006-6233.2021.02.029

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摘要 目的: 比较替格瑞洛和氯吡格雷对老年(年龄≥60岁)ASTEMI患者急诊PCI后并发症及预后的影响。方法: 将本院2017年4月至2019年4月108例行急诊PCI术的老年ASTEMI患者作为研究对象,采用简单随机分组法,分为对照组给予负荷剂量氯吡格雷治疗,研究组采用负荷剂量替格瑞洛治疗,两组各54例。比较两组患者手术前后TIMI血流分级、术后无复流和术后3个月内恶性心律失常、呼吸困难、出血及MACE的发生情况。结果: 研究组术后冠状动脉TIMI血流分级为3级的比例(92.59%)较对照组(75.93%)明显升高,且术后无复流及慢复流发生率(7.41%)较对照组(25.93%)明显降低(P<0.05)。研究组术后3个月内支架血栓、再发心肌梗死及心源性死亡发生率较对照组均明显降低(均P<0.05);而两组患者卒中发生率的比较,并无明显差异(P>0.05)。两组患者术后3个月内发生恶性心律失常、上消化道出血和颅内出血发生率的比较,均无明显差异(均P>0.05)。结论: 临床中对行急诊PCI术的老年ASTEMI患者应用替格瑞洛进行抗栓治疗具有确切的临床疗效,且具有良好的安全性,可有效改善患者的预后效果。

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关键词 ：急性ST段抬高型心肌梗死, 经皮冠状动脉介入术, 氯吡格雷, 替格瑞洛

Abstract：Objective: To compare the effects of ticagrelor and clopidogrel on postoperative complications and prognosis in elderly patients (aged ≥ 60 years) with ASTEMI after emergency PCI. Methods: 108 elderly patients with ASTEMI who underwent emergency PCI in our hospital from April 2017 to April 2019 were randomly divided by simple random grouping method into control group receiving loading dose of clopidogrel and study group receiving loading dose of ticagrelor, with 54 cases in each group. Blood flow classification before and after TIMI, postoperative no-reflow and malignant arrhythmia, dyspnea, hemorrhage and MACE3 months after surgery were compared between the two groups. Results: The proportion of TIMI grade 3 (92.59%) in the study group was significantly increased in comparison of the control group (75.93%), and the incidence rate of no-reflow and slow reflow (7.41%) was significantly decreased in comparison of the control group (25.93%) (P<0.05). The incidence rate of stent thrombosis, recurrent myocardial infarction and cardiac death in the study group was significantly decreased in comparison of the control group within 3 months after operation (all P<0.05), but there was no significant difference in the incidence rate of stroke between the two groups (P>0.05). There was no significant difference in the incidence rate of malignant arrhythmia, upper gastrointestinal bleeding and intracranial hemorrhage between the two groups within 3 months after operation (P>0.05). Conclusion: The antithrombotic therapy with ticagrelor in elderly patients with ASTEMI undergoing emergency PCI has definite clinical efficacy and good safety, and can effectively improve the prognosis.

Key words： Acute ST-segment elevation myocardial infarction Percutaneous coronary intervention Clopidogrel Ticagrelor

基金资助:辽宁省自然科学基金项目,(编号:201802035)

引用本文:

田峰, 白晓梅, 王桂东. 替格瑞洛和氯吡格雷对老年急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后并发症及预后的影响[J]. 河北医学, 2021, 27(2): 313-317.
TIAN Feng, BAI Xiaomei, WANG Guidong. Effects of Ticagrelor and Clopidogrel on Postoperative Complications and Prognosis in Elderly Patients with Acute ST-Segment Elevation Myocardial Infarction After Emergency Percutaneous Coronary Intervention. HeBei Med, 2021, 27(2): 313-317.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2021.02.029 或 http://www.hbyxzzs.cn/CN/Y2021/V27/I2/313

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