替格瑞洛对STEMI患者急诊PCI治疗前后Tp-e、Tp-e/QTc比值影响的研究

摘要

Objective To discuss the influence and clinical significance of oral loading dose of ticagrelor before emergency percutaneous coronary intervention (PCI) and oral maintenance dose of ticagrelor after emergency PCI on Tp-e and ratio of Tp-e to QTc (Tp-e/QTc) in patients with ST-segment elevation myocardial infarction (STEMI).Methods The patients with definitive diagnosed STEMI (n=68) were chosen and randomly divided into ticagrelor group and clopidogrel group (eachn=34). The changes of Tp-e and Tp-e/QTc were observed before PCI and 24 h after PCI.Results Among 68 patients, there were 22 with ventricular arrhythmias (AV) before emergency PCI and on one with AV after emergency PCI. Tp-e and Tp-e/QTc were significantly longer in AV patients than those in non-AV patients (P<0.05). Tp-e and Tp-e/QTc were significantly shorter after PCI than before in clopidogrel group (P<0.05) and also in ticagrelor group (P<0.01). The shortening of Tp-e and Tp-e/QTc was more significant in ticagrelor group compared with clopidogrel group (P<0.05).Conclusion The decreases of Tp-e and Tp-e/QTc are more significant in STEMI patients given loading dose of ticagrelor before emergency PCI and oral maintenance dose of ticagrelor after emergency PCI. The incidence of AV is correlated to the extension of Tp-e and Tp-e/QTc in STEMI patients.%目的：探讨急性ST段抬高型心肌梗死（STEMI）患者急诊行经皮冠状动脉介入治疗（PCI）术前给予负荷剂量的替格瑞洛口服及术后给予维持剂量口服治疗对T波峰末间期（Tp-e）、Tp-e/校正QT间期（QTc）比值的影响及临床意义。方法入选68例明确诊断为STEMI的患者并随机分为两组，即替格瑞洛组（n=34）与氯吡格雷组（n=34），观察两组在治疗前及治疗后24 h的Tp-e、Tp-e/QTc比值变化。结果68例患者中，急诊PCI治疗前有22例出现室性心律失常，急诊PCI后无室性心律失常出现，Tp-e、Tp-e/QTc比值在室性心律失常组较非室性心律失常组明显延长（P＜0.05）；氯吡格雷组PCI术后Tp-e、Tp-e/QTc比值较术前有明显缩短（P＜0.05），替格瑞洛组PCI后Tp-e、Tp-e/QTc比值较术前有明显缩短（P＜0.01），与氯吡格雷组比较，替格瑞洛组Tp-e、Tp-e/QTc比值缩短更明显（P＜0.05）。结论STEMI患者急诊PCI术前给予负荷剂量的替格瑞洛及术后给予维持剂量口服，Tp-e、Tp-e/QTc比值下降更明显；STEMI患者室性心律失常发生率与Tp-e、Tp-e/QTc比值延长有相关性。