摘要
目的探讨院前应用负荷剂量阿司匹林联合替格瑞洛对急性ST段抬高型心肌梗死(STEMI)患者急诊介入治疗有效性和心功能的影响。方法选取2022年1月至2024年1月我院急诊科收治的急性STEMI患者154例,依据院前是否应用抗负荷量阿司匹林和替格瑞洛进行分组为A组(n=77)和B组(n=77)。A组为我院120接诊入院后行急诊介入治疗的急性STEMI患者,在院前给予负荷量阿司匹林和替格瑞洛嚼服;B组为外院120送达我院以及自行来我院就诊的急性STEMI患者,入院后给予服用负荷量阿司匹林和替格瑞洛并接受急诊介入治疗。比较两组患者的心功能指标及血管再通率、心肌损伤标志物、冠脉血流动力学指标、血小板活化功能、严重心血管事件发生率及治疗安全性。结果A组的血管再通率为92.21%(71/77),高于B组的80.52%(62/77),差异有统计学意义(P<0.05)。A组的左室射血分数(LVEF)高于B组,左心室舒张末期内径(LVEDD)、氨基末端脑利钠肽前体(NTpro-BNP)低于B组,差异均有统计学意义(均P<0.05)。A组患者的肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、肌红蛋白(MYO)、谷草转氨酶(AST)水平均低于B组,差异均有统计学意义(均P<0.05)。A组患者冠状动脉收缩期最大流速(PSV)、舒张末期血流速度(EDV)、搏动指数(PI)均高于B组,阻力指数(RI)低于B组,差异均有统计学意义(均P<0.05)。A组患者的血小板聚集指数(PAI)、颗粒膜蛋白-140(GMP-140)、血小板活化因子(PAF)均低于B组,差异均有统计学意义(均P<0.05)。两组患者的严重心血管事件发生率比较,A组为6.49%(5/77)低于B组的19.48%(15/77),差异有统计学意义(P<0.05)。两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论急性STEMI患者院前服用负荷量阿司匹林联合替格瑞洛的效果良好,可提高介入治疗的血管再通率,改善心功能和血小板活化功能,降低心肌损伤标志物水平,且安全性高。
Objective To explore the effect of pre-hospital administration of loading dose aspirin combined with ticagrelor on the rate of vascular recanalization and improvement of cardiac function in patients with acute STEMI undergoing emergency interventional therapy.Methods A total of 154 patients with acute STEMI admitted to the emergency department of our hospital from January 2022 to January 2024 were selected and divided into group A and group B based on whether they received dual antiplatelet loading dose before hospitalization.Group B(77 cases)consisted of patients with acute STEMI who were treated with emergency interventional therapy after being admitted by our hospital's 120 ambulance and were given a dual antiplatelet loading dose(aspirin 300 mg+ticagrelor 180 mg)to chew in the ambulance.Group A(77 cases)consisted of patients with acute STEMI who were transferred to our hospital by 120 ambulances from other hospitals or came to our emergency department on their own and received a dual antiplatelet loading dose after admission.None of the patients in this group received a dual antiplatelet loading dose before hospitalization.The rate of vascular recanalization,cardiac function indicators,myocardial injury markers,coronary hemodynamics,platelet activation function,incidence of severe cardiovascular events(such as malignant arrhythmia,cardiogenic shock,cardiac arrest,etc.)and treatment safety were evaluated and compared between the two groups after emergency interventional therapy.Results The rate of vascular recanalization after emergency interventional therapy in group B was 92.21%(71/77),which was higher than that in group A(80.52%,62/77)(P<0.05).After interventional therapy,the left ventricular ejection fraction(LVEF)in group B was higher than that in group A,while the left ventricular end-diastolic diameter(LVEDD)and N-terminal pro-brain natriuretic peptide(NT-proBNP)were lower than those in group A(all P<0.05).The levels of creatine kinase isoenzyme(CK-MB),cardiac troponin T(cTnT),myoglobin(MYO),and aspartate aminotransferase(AST)in group B were lower than those in group A(all P<0.05).After treatment,the peak systolic velocity(PSV),end-diastolic velocity(EDV),and pulsatility index(PI)of coronary arteries in group B were higher than those in group A,while the resistance index(RI)was lower than that in group A(P<0.05).The platelet aggregation index(PAG),granular membrane protein-140(GMP-140),and platelet activating factor(PAF)in group B were lower than those in group A(all P<0.05).The incidence of severe cardiovascular events in group B after admission was 6.49%(5/77),which was lower than that in group A(19.48%,15/77)(P<0.05).The incidence of adverse reactions during treatment was 11.69%(9/77)in group B versus 9.09%(7/77)in group A(P>0.05).Conclusion Pre-hospital administration of loading dose aspirin combined with ticagrelor in patients with acute STEMI has a good effect,which can improve the rate of vascular recanalization,cardiac function,platelet activation function,and reduce the levels of myocardial injury markers and the incidence of severe cardiovascular events.
作者
黄国亮
毛坡
李江平
HUANG Guoliang;MAO Po;LI Jiangping(Emergency Center of Anxi County Hospital,Anxi County,Fujian Province,362400,China)
出处
《蛇志》
2025年第2期172-177,共6页
Journal of Snake
关键词
急性ST段抬高型心肌梗死
阿司匹林
替格瑞洛
血管再通率
心功能
Acute ST-segment elevation myocardial infarction
Aspirin
Ticagrelor
Vascular revascularization rate
Cardiac function
