学术论文

      急性冠脉综合征经皮冠状动脉介入治疗术后不同抗血小板方案对 QT 离散度的影响

      Effect of different anti -platelet therapies on QT dispersion in patients with acute coronary syndrome after percutaneous coronary intervention

      摘要:
      目的:探讨急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗术(PCI)后不同抗血小板治疗方案对 QT 离散度(Qtd,QTcd)的影响。方法选择80例接受 PCI 术治疗 ACS 患者,按照随机数字表法分为对照组与观察组各40例,对照组术后应用常规抗血小板治疗方案,口服阿司匹林+氯吡格雷,观察组给予强化抗血小板治疗方案,在对照组基础上加用替罗非班,比较两组治疗前后血小板聚集功能及炎症指标的变化,心电图监测治疗前后两组 QT 离散度的变化,两组均随访1年,统计不良事件发生率。结果治疗前,两组血小板聚集指标(mPAR、PRU)、高敏 C 反应蛋白(hs-CRP)、可溶性白细胞分化抗体40配体(sCD40L)水平及QT 离散度差异无统计学意义(P >0.05);治疗后,观察组 MPAR、PRU 均低于对照组[(30.26±8.42)%、(114.36±10.26)U 比(39.33±9.4)%、(143.86±12.65)U](t =4.542、11.454,均 P <0.05),其 hs-CRP、sCD40L 低于对照组[(2.12±0.62)mg/L、(1.71±0.94)μg/L 比(2.94±0.44)mg/L、(2.76±1.23)μg/L](t =6.748、4.289,均 P <0.05),且 QTd、QTcd 低于对照组[(25.41±3.32)ms、(26.12±4.26)ms 比(29.52±2.98)ms、(30.51±3.97)ms](t =5.826、4.768,均 P <0.05);观察组随访期间支架内再狭窄或血栓形成发生率低于对照组(2.50%比15.00%)(χ2=3.913,P <0.05)。结论 ACS 患者 PCI 术后采用替罗非班强化抗血小板治疗,可减轻患者机体炎性反应,降低血小板聚集率,缩短 QT 离散度,降低术后不良事件发生率。
      Abstract:
      Objective To investigate the effect of anti -platelet therapy on QT dispersion(Qtd,QTcd)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods 80 patients with ACS and undergoing PCI were divided into the control group and the observation group by the random number table method,40 cases in each group.The control group was treated with routine antiplatelet therapy,oral administra-tion of aspirin and clopidogrel,while the observation group was treated with intensive antiplatelet therapy and tirofiban based on the treatment in the control group.The changes of platelet aggregation function and inflammation indices before and after treatment were compared between the two groups.The changes of QT dispersion in the two groups were monitored by electrocardiogram.Both two groups were followed up for 1 year,and the incidence rate of adverse events was analyzed statistically.Results Before treatment,there were no significant differences in platelet aggrega-tion indices (MPAR,PRU),levels of inflammatory factors (hs -CRP,sCD40L)and QT dispersion between the two groups (all P >0.05).After treatment,MPAR and PRU in the observation group were lower than those in the control group[(30.26 ±8.42)%,(114.36 ±10.26)U vs.(39.33 ±9.4)%,(143.86 ±12.65)U](t =4.542,11.454,all P <0.05),the levels of hs -CRP and sCD40L were lower than those in the control group[(2.12 ±0.62 )mg/L, (1.71 ±0.94)μg/L vs.(2.94 ±0.44)mg/L,(2.76 ±1.23)μg/L](t =6.748,4.289,all P <0.05),and QTd and QTcd were also lower than those in the control group [(25.41 ±3.32)ms,(26.12 ±4.26 )ms vs.(29.52 ± 2.98)ms,(30.51 ±3.97)ms](t =5.826,4.768,all P <0.05).During the follow -up,the incidence rate of rest-enosis or thrombosis in stent of the observation group was lower than that of the control group (2.50% vs.15.00%) (χ2 =3.913,P <0.05).Conclusion The application of tirofiban anti -platelet therapy in patients with ACS after PCI can reduce the inflammatory responses,reduce platelet aggregation rate,shorten QT dispersion and reduce the&nbsp;incidence of adverse events.
      作者: 袁义燕
      Author: Yuan Yiyan
      作者单位: 郑州市第七人民医院心电图室, 河南省郑州,450000
      刊 名: 中国基层医药 ISTIC
      年,卷(期): 2017, 24(6)
      在线出版日期: 2017年3月29日