[1]詹小娜,包恩泽,李贵华,等.替格瑞洛联合小剂量替罗非班对行急诊经皮冠状动脉介入术老年急性ST段抬高型心肌梗死患者梗死相关动脉血流及主要不良心血管事件的影响[J].新乡医学院学报,2018,35(7):584-587.[doi:10.7683/xxyxyxb.2018.07.009]
　ZHAN Xiao-na,BAO En-ze,LI Gui-hua,et al.Effect of ticagrelor combined with low dose tlrofiban on infarction artery blood flow & major adverse cardiovascular events elder patients with acute ST elevated myocardial infarction undergoing emerg[J].Journal of Xinxiang Medical University,2018,35(7):584-587.[doi:10.7683/xxyxyxb.2018.07.009]
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替格瑞洛联合小剂量替罗非班对行急诊经皮冠状动脉介入术老年急性ST段抬高型心肌梗死患者梗死相关动脉血流及主要不良心血管事件的影响
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年7
页码:
584-587
栏目:
临床研究
出版日期:
2018-07-05

文章信息/Info

Title:
Effect of ticagrelor combined with low dose tlrofiban on infarction artery blood flow & major adverse cardiovascular events elder patients with acute ST elevated myocardial infarction undergoing emerg
作者:
詹小娜; 包恩泽; 李贵华; 王亚娟; 高　蕾; 富丽娟
（北京市垂杨柳医院心脏中心，北京　100022）
Author(s):
ZHAN Xiao-na; BAO En-ze; LI Gui-hua; WANG Ya-juan; GAO Lei; FU Li-juan
（Department of Heart Center，Chuiyangliu Hospital of Beijing，Beijing 100022，China）
关键词:
替格瑞洛; 替罗非班; 急性ST段抬高型心肌梗死; 经皮冠状动脉介入术
Keywords:
ticagrelor; tirofiban; ST-segment elevation myocardial infarction; percutaneous coronary intervention
分类号:
R542.2+2
DOI:
10.7683/xxyxyxb.2018.07.009
文献标志码:
A
摘要:
目的　探讨替格瑞洛联合小剂量替罗非班对行急诊经皮冠状动脉介入术（PCI）老年急性ST段抬高型心肌梗死（STEMI）患者梗死相关动脉（IRA）血流及主要不良心血管事件（MACE）的影响。方法　选择2016年3月至2017年3月在北京市垂杨柳医院心脏中心确诊为STEMI并行急诊PCI的老年患者105例为研究对象，根据治疗方法将患者分为观察组（n=50） 和对照组（n=55）。2组患者均行PCI，术前均给予负荷量阿司匹林 300 mg及替格瑞洛180 mg，嚼服；在此基础上，观察组患者经导管冠状动脉内注射替罗非班 5 μg·kg-1，术后继续给予替罗非班0.07 μg·kg-1·min-1静脉泵入36 h；对照组患者经导管冠状动脉内注射替罗非班10 μg·kg-1，术后继续给予替罗非班0.15 μg·kg-1·min-1静脉泵入36 h。观察2组患者PCI术中IRA无复流或慢血流、6个月内MACE及出血等不良反应情况。结果　对照组患者PCI术中IRA无复流和慢复流的发生率均为3.6%（2/55），观察组患者PCI术中IRA无复流和慢复流的发生率均为2.0%（1/50），2组患者PCI术中IRA无复流和慢复流的发生率比较差异无统计学意义（χ2=0.090、0.090，P>0.05）。对照组和观察组患者MACE发生率分别为23.6%（13/55）和10.0%（5/50），2组患者MACE发生率比较差异无统计学意义（χ2=3.429，P>0.05）。对照组和观察组患者轻度出血发生率分别为16.4%（9/55）、4.0%（2/50），观察组患者轻度出血发生率低于对照组（χ2=4.269，P<0.05）。对照组和观察组患者Ⅰ度血小板减少发生率分别为9.1%（5/55）、4.0%（2/50），2组患者均未出现Ⅱ度以上的血小板减少；对照组和观察组患者非心源性呼吸困难发生率分别为3.6%（2/55）、6.0%（3/59）；2组患者血小板减少和非心源性呼吸困难发生率比较差异均无统计学意义（χ2=0.426、0.012，P>0.05）。结论　替格瑞洛联合小剂量替罗非班可有效改善行急诊PCI老年STEMI患者的IRA血流，且出血风险低，不良反应轻。
Abstract:
Objective　To investigate the effect of ticagrelor combined with low dose tlrofiban on infarction related artery(IRA) blood flow and major adverse cardiovascular events(MACE) in elderly patients with acute ST-segment elevated myocardial infarction（STEMI） undergoing emergency percutaneous coronary intervention（PCI）.Methods　One hundred and five elderly STEMI patients who underwent emergency PCI in Department of Heart Center，Chuiyangliu Hospital of Beijing from March 2016 to March 2017 were selected as the study subjects.All patients were divided into control group（n=55） and observation group（n=50） according to the treatment method.All patients were given PCI.Before the PCI，all patients were given aspirin 300 mg and ticagrelor 180 mg for chewing.Based on this，the low dose of tirofiban （5 μg·kg-1） was injected into the coronary artery by catheter in the patients of observation group，and the low dose of tirofiban （0.07 μg·kg-1·min-1） was continued to give by intravenous continuous pumping for 36 h after PCI；the routine dose of tiropin（10 μg·kg-1） was injected into the coronary artery by catheter in the patients of control group，and the routine dose of tiropin （0.15 μg·kg-1·min-1） was continued to give by intravenous continuous pumping for 36 h after PCI.The incidence of no reflow and slow blood flow during PCI，the MACE in 6 months after discharge from hospital and adverse reactions were observed in the two groups.Results　The incidence of no reflow during PCI of patients in the control group and observation group was 3.6%（2/55）and 2.0%（1/50），the incidence of slow blood flow during PCI of patients in the control group and observation group was 3.6%（2/55）and 2.0%（1/50）；there was no statistic difference in the incidence of no reflow and slow blood flow during PCI between the two groups（χ2=0.900,0.090;P>0.05）.The incidence of MACE of patients in the control group and observation group was 23.6%（13/55）and 10.0%（5/50）respectively；there was no statistic difference in the incidence of MACE between the two groups（χ2=3.429,P>0.05）.No major bleeding were found in the both groups.The incidence of slight bleeding in the control group and observation group was 16.4%（9/55） and 4.0%（2/50） respectively；the incidence of bleeding in the observation group was significanlty lower than that in the control group （χ2=4.269,P<0.05）.There was no above degree Ⅱ thrombocytopenia in the two groups.The incidence of degree Ⅰ thrombocytopenia in the control group and observation group was 9.1% （5/55） and 4.0% （2/50） respectively；the incidence of non cardiac dyspneain the control group and observation group was 3.6%（2/55）and 6.0%（3/50） respectively；there was no statistic difference in the incidence of degree Ⅰ thrombocytopenia and non cardiac dyspnea between the two groups（χ2=0.426,0.012;P>0.05）.Conclusion　Ticagrelor combined with low dose tyropiban can effectively improve the IRA blood flow in elderly STEMI patients who undergo emergency PCI and with low bleeding risk and mild adverse reactions.

参考文献/References:

［1］　丁华永.血栓抽吸技术在经皮冠状动脉介入治疗急性前壁ST段括商型心肌梗死老年患者中的应用价值［J］.新乡医学院学报，2016，33（9）：801-803.
［2］　THIELE H，DESCH S，DE WAHA S.Acute myocardial infarction in patients with ST-segment elevation myocardial infarction：ESC guidelines 2017［J］.Herz，2017，42（8）：728-738.
［3］　LEVINE G N，BATES E R，BLANKENSHIP J C，et al.2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction：an update of the 2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention and the 2013 ACCF/AHA Guideline for the management of ST-elevation myocardial infarction［J］.Am Coll Cardiol，2016，67（10）：1235-1250.
［4］　WALENTIN L，BECKER R C，BUDAJ A，et al.Ticagrelor versus clopidogrel in patients with acute coronary syndromes［J］.N Engl J Med，2009，361（11）：1045-1057.
［5］　中国抗癌协会临床肿瘤学协作专业委员会.肿瘤化疗所致血小板减少症诊疗中国专家共识（2014版）［J］.中华肿瘤杂志，2014，11（36）：876-879.
［6］　中华医学会心血管学分会，中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南［J］.中华心血管病杂志，2015，43（5）：380-393.
［7］　中华医学会心血管病学分会介入心脏病学组，中国医师协会心血管内科医师分会血栓防治专业委员会，中华心血管病杂志编辑委员会组织专家组.中国经皮冠状动脉介入治疗指南（2016） ［J］.中华心血管病杂志，2016，44（5）：382-400.
［8］　ITO H.No-reflow phenomenon in patients with acute myocardial infarction：its pathophysiology and clinical implications［J］.Acta Med Okayama，2009，63（4）：161-168.
［9］　DANGAS G D，CAIXETA A，MEHRAN R，et al.Frequency and predictors of stent thrombosis after pereutaneous coronary intervention in acute myocardial infarction［J］.Circulation，2011，123（16）：1745-1756.
［10］　KIMURA T，MORIMOTO T，KOZUMA K，et al.Comparisons of baseline demographics，clinical presentation，and long-term outcome among patients with early，late，and very late stent thrombosis of sirolimus-eluting stents：observations from the Registry of Stent Thrombosis for Review and Reevaluation（RESTART）［J］.Circulation，2010，122（1）：52-61.
［11］　中国医师协会心血管内科医师分会血检防治专业委员会，中华医学会心血管病学分会介入学组，中华心血管病杂志编辑委员会.替格瑞洛临床应用中国专家共识［J］.中华心血管病杂志，2016，44（2）：112-120.
［12］　AKPEK M，SAHIN O，SARLI B，et al.Acute effects of intracoronary tirofiban on no-reflow phenomena in patients with ST segment elevated myocardial infarction undergoing primary percutaneous coronary intervention［J］.Angiology，2015，66（6）：560-567.
［13］　SEREBRUANY V L.Viewpoint：paradoxical excess mortality in the PLATO trial should be independently verified［J］.Thromb Haemost，2011，105（5）：752-759.
［14］　SAHL N A，CHRISTOPH V，BO L，et al.Outcomes in patients treated with ticagrelor or clopidogrel after acute myocardial infarction：experiences from SWEDEHEART registry［J］.Eur Heart J，2016，37（44）：3335-3342.

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更新日期/Last Update: 2022-03-16