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目的观察替格瑞洛和氯吡格雷对急性心肌梗死溶栓后择期经皮冠状动脉介入治疗(PCI)患者的临床疗效与安全性。方法将130例急性ST段抬高型心肌梗死患者随机分为对照组64例和试验组66例。对照组予以口服氯吡格雷首次剂量300 mg,维持剂量75 mg,qd;试验组予以口服替格瑞洛首次剂量180mg,维持剂量90 mg,bid。2组患者均在起病8~12 d成功接受PCI手术。比较2组患者的术后心肌梗死溶栓治疗临床试验(TIMI)血流分级、术前和术后左心室射血分数(LVEF)和左心室舒张末期内径(LVEDD),术后无复流/慢血流及出血事件的发生率。结果术后,试验组的TIMI血流分级及LVEF均显著高于对照组(P<0.01),试验组的LVEDD低于对照组(P<0.01)。术后,试验组的无复流/慢血流发生率为3.03%显著低于对照组的14.06%(P<0.05)。2组患者均只发生轻微出血事件,但术后6个月出血事件发生率比较差异无统计学意义(P>0.05)。结论替格瑞洛在急性心肌梗死溶栓后择期PCI手术中有较好的临床疗效,可显著改善患者术后TIMI血流,有更强的抗血小板聚集功能,且不增加出血事件的发生率。
Objective To observe the clinical efficacy and safety of ticagrelor and clopidogrel in patients undergoing elective PCI during acute myocardial infarction. Methods A total of 130 patients with acute ST-segment elevation myocardial infarction were randomly divided into control group (64 cases) and experimental group (66 cases). The control group was given oral clopidogrel first dose of 300 mg, maintenance dose of 75 mg, qd; test group was given the first dose of ticagrelor 180 mg, maintenance dose 90 mg, bid. Both groups were successfully treated with PCI during 8-12 days of onset. The TIMI flow classification, preoperative and postoperative left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) were compared between the two groups. The postoperative no-reflow / Slow blood flow and the incidence of bleeding events. Results After operation, the TIMI grade and LVEF in the experimental group were significantly higher than those in the control group (P <0.01). LVEDD in the experimental group was lower than that in the control group (P <0.01). Postoperatively, the rate of no-reflow / slow blood flow in the experimental group was significantly lower than that of the control group (3.03% vs 14.06%, P <0.05). There was only mild bleeding in both groups, but there was no significant difference in the incidence of bleeding after 6 months (P> 0.05). Conclusion Ticagrelor has better clinical curative effect in elective PCI after thrombolytic therapy of acute myocardial infarction, and can significantly improve postoperative TIMI blood flow, have stronger anti-platelet aggregation function, and does not increase the incidence of bleeding events .