硫酸氢氯吡格雷片结合高压氧对行TRA-pPCI冠心病患者的疗效观察

目的探讨硫酸氢氯吡格雷片结合高压氧对行经桡动脉冠状动脉介入治疗(TRA-pPCI)冠心病患者的疗效及可溶性E选择素(sE-selectin)、脂联素(ADPN)水平的影响。方法选取2016年7月至2018年10月在山西医科大学第一医院行TRA-pPCI的冠心病患者108例,按照数字表法随机分为对照组和研究组,每组54例。2组患者术前术后均应用硫酸氢氯吡格雷片治疗,研究组患者术后给予高压氧治疗。比较2组患者的临床疗效、出院后1年随访的主要不良心脑血管事件发生情况、治疗前后血脂水平、颈动脉斑块面积、颈动脉内膜中层厚度(IMT)、血清炎性因子、sE-selectin和ADPN水平。结果研究组患者治疗总有效率为96.30%,明显高于对照组(81.48%),差异有统计学意义(P<0.05);随访1年后,研究组主要不良心脑血管事件发生率为11.11%,明显低于对照组(44.44%),差异有统计学意义(P<0.01)。2组患者治疗后总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)和超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α) 、γ干扰素(IFN-γ)、白细胞介素-10(IL-10)水平、颈动脉斑块面积和IMT相比治疗前均明显降低或减小,高密度脂蛋白胆固醇(HDL-C)水平较治疗前明显升高;治疗后研究组患者TC、TG、LDL-C、hs-CRP、TNF-α、IFN-γ、IL-10水平、颈动脉斑块面积和IMT相比对照组明显降低或减小,HDL-C水平明显升高,差异均有统计学意义(P<0.05或P<0.01)。2组患者治疗后血清sE-selectin水平较治疗前明显降低,ADPN水平较治疗前明显升高;治疗后研究组与对照组比较,血清sE-selectin明显降低,ADPN水平明显升高,差异均有统计学意义(P<0.05或P<0.01)。结论硫酸氢氯吡格雷片结合高压氧治疗能有效改善行TRA-pPCI冠心病患者的血脂、血清炎性因子和血清sE-selectin、APN水平,抑制动脉粥样硬化斑块的形成,减少术后不良心脑血管事件的发生,提高冠心病的治疗效果。

Effect of clopidogrel bisulfate tablets combined with hyperbaric oxygen on patients with coronary heart disease after TRA-pPCI

Objective To investigate the effect of clopidogrel bisulfate tablets combined with hyperbaric oxygen on patients with coronary heart disease after trans-radial access primary percutaneous coronary intervention(TRA-pPCI),and to investigate its influence on the levels of sE-selectin and Adiponectin(ADPN).Methods A total of 108 patients with coronary heart disease after TRA-pPCI admitted in the Health Management Center of the First Hospital of Shanxi Medical University from July 2016 to October 2018 were randomly divided into control group and observation group,with 54 patients in each group.Both groups were treated with clopidogrel sulfate tablets before and after the operation.The patients in the observation group were additionally treated with hyperbaric oxygen after operation.Clinical efficacy,incidence of major adverse cardiovascular and cerebrovascular events during one-year follow-up after the discharge,blood lipid levels before and after treatment,carotid plaque area,carotid intima-media thickness(IMT),serum inflammatory factors,sE-selectin and ADPN levels were compared between the two groups.Results The total effective rate of the observation group(96.30%)was significantly higher than that of the control group(81.48%)with statistically significant difference(P<0.05);the incidence of major adverse cardiovascular and cerebrovascular events during one-year follow-up in the observation group(11.11%)was significantly lower than that of the control group(44.44%)with statistically significant difference(P<0.01).Compared with those before treatment,the levels of TC,TG,LDL-C,hs CRP,TNF-α,IFN-γ,IL-10,carotid plaque area,and IMT of the two groups after the treatment decreased significantly,while HDL-C increased significantly;and the differences of blood lipid level,carotid plaque area,and IMT after treatment between the two groups were statistically significant(P<0.05 or P<0.01).The serum levels of sE-selectin of the two groups were significantly lower than those before the treatment,while ADPN levels were significantly higher.And the differences in serum sE-selectin and APN levels between the two groups were statistically significant(P<0.05 or P<0.01).Conclusion Clopidogrel bisulfate tablets combined with hyperbaric oxygen therapy can effectively regulate the levels of blood lipid,serum inflammatory factors,serum sE-selectin and ADPN levels in patients with coronary heart disease after TRA-pPCI,and inhibit the formation of atherosclerotic plaque,thereby effectively reducing the incidence of adverse cardiovascular and cerebrovascular events after operation and improving the therapeutic effect on coronary heart disease.