尿激酶溶栓联合替罗非班或替格瑞洛抗血小板治疗急性ST段抬高型心肌梗死效果分析

目的:探讨尿激酶溶栓联合替罗非班或替格瑞洛抗血小板治疗急性ST段抬高型心肌梗死(STEMI)患者的疗效.方法:根据不同治疗方案将148例STEMI患者分为替罗非班组、替格瑞洛组与氯吡格雷组,分别联合尿激酶溶栓治疗,连续干预7d,比较各组治疗后心肌再灌注指标、治疗前后心功能、心肌损伤标志物、超敏-C反应蛋白(hs-CRP)及30d不良事件情况.结果:与氯吡格雷组比较,替罗非班组、替格瑞洛组治疗后ST段回落>50％、肌梗死溶栓治疗(TIMI)3级血流、心肌灌注分级(TMP)3级比率、左室射血分数(LVEF)均显著高,左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)、hs-CRP水平均显著低,差异有统计学意义(P<0.05),而替罗非班组与替格瑞洛组上述指标比较差异均无统计学意义(P>0.05);三组30d不良事件发生率比较差异无统计学意义(P>0.05).结论:尿激酶溶栓联合替罗非班或替格瑞洛治疗STEMI相比氯吡格雷能明显改善患者心功能,减轻心肌损伤及炎症反应,短期预后效果类似;替罗非班、替格瑞洛治疗效果相当.

Urokinase Thrombolysis Combined with Tirofiban or Ticagrelor Antiplatelet in the Treatment of Acute STEMI

Objective:To investigate the effects of urokinase thrombolysis combined with tirofiban or ti-cagrelor antiplatelet therapy in the treatment of acute ST segment elevation myocardial infarction ( STEMI ) . Methods:According to the treatment methods, 148 cases of patients with STEMI were divided into tirofiban group, ticagrelor group and clopidogrel group. The three groups were treated with urokinase thrombolysis for 7 days. The myocardial reperfusion indexes, cardiac function, myocardial injury markers, inflammation related indicators and 30d adverse events were compared among groups. Results: Compared with clopidogrel group, the ratios of ST segment decline > 50％, grade 3 blood flow of thrombolysis in myocardial infarction ( TIMI) and grade 3 myocardial perfusion ( TMP ) and left ventricular ejection fraction ( LVEF ) were significantly higher in tirofiban group and ticagrelor group after treatment; while the left ventricular end diastolic diameter ( LVEDD) , left ventricular end systolic diameter ( LVESD) , levels of serum creatine kinase isoenzyme ( CK-MB) , cardiac troponin ( cTnI) , high-sensitivity C reactive protein ( hs-CRP ) and tumor necrosis factor α( TNF-α) were significantly lower ( P < 0.05) . There were no statistically significant differences between the tirofiban and the ticagrelor group ( P > 0.05) . There was no significant difference in the incidence of adverse events in 30 days among the three groups ( P > 0.05) . Conclusion:The application of urokinase thrombolysis combined with tirofiban or ticagrelor antiplatelet therapy in the treatment of STEMI can significantly improve cardiac function and reduce myocardial injury and inflammatory response. The short-term prognosis is similar, and the curative effect of tirofiban and ticagrelor is similar.