替格瑞洛在冠脉搭桥术治疗急性ST段抬高性心肌梗死的临床疗效

目的:探讨替格瑞洛在冠脉搭桥术治疗急性ST段抬高性心肌梗死的临床疗效。方法:选取急性ST段抬高性心肌梗死患者387例。术前冠脉造影证实存在冠脉血管左主干病变或严重弥漫冠脉血管病变的患者共221例，其中65例行急诊经皮冠状动脉介入（PCI）治疗，40例行溶栓治疗，余116例患者因存在急诊PCI困难或超过溶栓治疗时间窗，建议限期行冠脉搭桥手术且获家属同意。随机平均分为替格瑞洛组（58例）、氯吡格雷组（58例），两组患者术前均予以降低心肌耗氧、改善冠脉供血等对症治疗。氯吡格雷组术前加用氯吡格雷口服，术后予以氯吡格雷+阿司匹林口服；替格瑞洛组术前加用替格瑞洛口服，术后予以替格瑞洛+阿司匹林口服。比较两组患者治疗后心电图ST段回落幅度、血小板聚集率变化情况、心功能指标及心血管不良事件发生率。结果:术后第1、12、24小时替格瑞洛组ST段回落程度大于氯吡格雷组（P＜0.05）；患者用药 5 d、10 d以及30 d血小板聚集率替格瑞洛组低于氯吡格雷组 （P＜0.05）；术后第1周左室射血分数、左室舒张末期内径及左室收缩末期内径两组无明显统计学差异（P＜0.05），术后第4周左室射血分数、左室舒张末期内径及左室收缩末期内径替格瑞洛组优于氯吡格雷组 （P≤0.05；心血管不良事件[不稳定性心绞痛 （UAP）、出血、急性心肌梗死（AMI）、心力衰竭（CF） ]发生率，替格瑞洛组低于氯吡格雷组 （P＜0.05）。结论:替格瑞洛可显著提高冠脉搭桥术治疗急性ST段抬高性心肌梗死患者临床疗效。

Clinical effect of ticagrelor in the treatment of acute ST segment elevation myocardial infarction in patients undergoing coronary artery bypass grafting

Objective: To evaluate the clinical effect of ticagrelor in the treatment for acute STEMI in patients who had undergone CABG.Methods: A total of 387 patients with acute STEMI were selected. Preoperative coronary angiography confirmed the left main coronary artery or diffuse coronary artery lesions in 221 patients, including 65 cases of emergency percutaneous coronary intervention (PCI) treatment, and 40 cases of thrombolytic therapy. Owing to the difficulty of interventional treatment, elective coronary artery bypass grafting surgery, the remaining 116 patients were advised to undergo coronary artery bypass surgery within a period of time and received the consent of their family members.The patients were randomly divided into two groups(each 58 patients): the ticagrelor group and the clopidogrel group. All patients were given preoperative myocardial oxygen consumption,coronary blood supply, anticoagulation, lipid regulation and other symptomatic treatment were improved. Clopidogrel group was treated with clopidogrel before oral administration, clopidogrel and aspirin after oral administration, and Grillo group was given oral administration of oral medicine, and after the operation, oral medication was offered.The decrease of ST segment in ECG, platelet aggregation rate, cardiac function index and cardiovascular adverse events were compared between the two groups after treatment. Results: The ST segment decline of ECG: 1 h, 12 h and 24 h after operation ,ticagrelor group was lower than that of clopidogrel group (P＜0.05). The platelet aggregation rate: after medication 5 d, 10 d and 30 d, ticagrelor group was lower than that of that of clopidogrel group (P ＜0.05); left ventricular ejection fraction, left ventricular end diastolic diameter and left ventricular and systolic diameter: after the first week, no significant difference between two groups was found (P＞0.05), but after 4 weeks, ticagrelor group was higher than that of clopidogrel group(P＜0.05); the incidence rate of cardiovascular adverse events （unstable angina pectoris (UAP), hemorrhage, heart failure (CF), acute myocardial infarction (AMI)）, ticagrelor group were lower than those of clopidogrel group (P＜0.05). Conclusion: After the treatment of ticagrelor,the clinical curative effect is improved significantly, for patients who suffered acute STEMI undergoing CABG.