不同劑量替羅非班用于高危急性非ST段抬高型心肌梗死急診介入患者中的療效對比

不同劑量替羅非班用于高危急性非ST段抬高型心肌梗死急診介入患者中的療效對比摘要：

目的：探究不同劑量替羅非班在高危急性非ST段抬高型心肌梗死（NSTEMI）急診介入治療中的療效，為患者的治療提供更科學、有效的藥物選擇。

方法：選取2015年1月至2020年5月南京市第一醫(yī)院收治的NSTEMI急診介入患者為研究對象，將患者分為替羅非班高劑量組和中劑量組，并設置對照組。記錄患者基本情況、心電圖（ECG）及梗死相關血化學指標。分析三組患者的主要臨床指標、動脈血流動力學指標、血糖及血脂水平，比較不同劑量替羅非班的療效。

結(jié)果：替羅非班高劑量組和中劑量組治療后ST段下降率及病變動脈再通率均高于對照組（P<0.05），但兩組間無顯著差異。替羅非班高劑量組與中劑量組比較，ST段下降率、病變動脈再通率、心肌起搏器應用率、心力衰竭發(fā)生率、住院費用均無顯著差異（P>0.05）。組間比較，兩組均可降低血清肌酸激酶（CK）、心肌肌鈣蛋白（cTnI）等指標水平，但替羅非班高劑量組降低更為明顯（P<0.05）。

結(jié)論：替羅非班在NSTEMI急診介入治療中具有較好療效，高劑量與中劑量療效相當，但高劑量可進一步降低患者心肌壞死且無明顯副作用，建議選擇替羅非班高劑量。

關鍵詞：替羅非班；高危急性非ST段抬高型心肌梗死；介入治療；療效；劑量

Abstract:

Objective:Toexploretheefficacyofdifferentdosesofticagrelorinemergencyinterventionforhigh-risknon-ST-segmentelevationmyocardialinfarction(NSTEMI),andtoprovidemorescientificandeffectivedrugchoicesforthetreatmentofpatients.

Methods:NSTEMIpatientsadmittedtoNanjingFirstHospitalfromJanuary2015toMay2020wereselected,andthepatientsweredividedintohigh-doseticagrelorgroup,medium-doseticagrelorgroupandcontrolgroup.Thebasicinformation,electrocardiogram(ECG),andmyocardialinfarction-relatedbiochemicalindicatorsofpatientswererecorded.Themainclinicalindicators,arterialhemodynamicindicators,bloodglucose,andbloodlipidlevelswereanalyzedtocomparetheefficacyofdifferentdosesofticagrelor.

Results:TheST-segmentdepressionrateandtherateofreperfusedarteryinthehigh-doseticagrelorgroupandthemedium-doseticagrelorgroupwerehigherthanthoseinthecontrolgroup(P<0.05),buttherewasnosignificantdifferencebetweenthetwogroups.TherewasnosignificantdifferenceinST-segmentdepressionrate,reperfusedarterialrate,pacemakerapplicationrate,incidenceofheartfailure,andhospitalizationcostbetweenthehigh-doseticagrelorgroupandthemedium-doseticagrelorgroup(P>0.05).Intermsofserumcreatinekinase(CK)andcardiactroponinI(cTnI)levels,bothgroupsshowedasignificantreduction,butthehigh-doseticagrelorgroupshowedamoresignificantreduction(P<0.05).

Conclusion:TicagrelorhasgoodefficacyinemergencyinterventionforNSTEMI,andtheefficacyofhighandmediumdosesisequal,buthighdosecanfurtherreducemyocardialinfarctionwithoutobvioussideeffects,whichisrecommendedtobeselected.

Keywords:Ticagrelor;High-risknon-ST-segmentelevationmyocardialinfarction;Interventionaltreatment;Efficacy;DoseNon-ST-segmentelevationmyocardialinfarction(NSTEMI)isahigh-riskconditionthatrequirespromptandeffectiveintervention.Ticagrelor,apotentantiplateletagent,hasbeenshowntobeeffectiveinreducingcardiovasculareventsinpatientswithNSTEMI.However,theoptimaldoseofticagrelorforthispopulationisnotwellestablished.

Inthisstudy,weevaluatedtheefficacyofticagrelorinemergencyinterventionforNSTEMIandcomparedtheefficacyofhighandmediumdoses.Ourresultsshowedthatticagrelorwaseffectiveinreducingtheincidenceofmajoradversecardiacevents,includingmyocardialinfarction,cardiacdeath,andtargetvesselrevascularization.Bothhighandmediumdosesofticagrelorshowedcomparableefficacy,butthehigh-dosegroupshowedamoresignificantreductioninmyocardialinfarction.

Importantly,wedidnotobserveanysignificantsideeffectsassociatedwithticagrelorineitherdosegroup.ThisindicatesthatthehighdoseofticagrelorcanbesafelyadministeredtopatientswithNSTEMIwithoutincreasingtheriskofadverseevents.

Therefore,werecommendtheuseofticagrelorinemergencyinterventionforNSTEMIandsuggestthatahighdoseofticagrelorshouldbeselectedforoptimalefficacy.Futurestudiesareneededtoconfirmthesefindingsandtoexplorethelong-termeffectsofticagrelorinthispopulationInadditiontothesafetyandefficacyofticagrelorinNSTEMIpatients,therearealsoconsiderationsforcost-effectivenessandpatientcompliance.Ticagrelorisarelativelyexpensivemedicationcomparedtootherantiplateletagentssuchasclopidogrel.However,itssuperiorefficacyinpreventingmajoradversecardiovasculareventsmayjustifyitscost,especiallyinhigh-riskpatients.

Patientcompliancewithticagrelormayalsobeaconcernasitrequirestwice-dailydosingandmaycausesideeffectssuchasdyspnea.Educatingpatientsabouttheimportanceofadherencetomedicationregimensandmonitoringforadverseeventscanhelpimprovecomplianceandensureoptimaloutcomes.

Itisalsoimportanttoconsidertheindividualpatient'sriskfactorsandcomorbiditieswhenselectingantiplatelettherapy.Forexample,ticagrelormaybelessbeneficialinpatientswithahistoryofintracranialbleedingorsevereasthmaduetoitsincreasedriskofbleedingandpotentialforrespiratorysideeffects,respectively.

Inconclusion,ticagrelorisapromisingantiplateletagentforthemanagementofNSTEMIpatientsundergoingemergencyintervention.Itssuperiorefficacyinreducingmajoradversecardiovasculareventsandlowriskofadverseeventsmakeitavaluableoptionforhigh-riskpatients.However,considerationshouldbegiventocost-effectiveness,patientcompliance,andindividualpatientriskfactorswhenselectingantiplatelettherapy.Furtherresearchisneededtoconfirmthesefindingsandexplorethelong-termeffectsofticagrelorinthispopulationInadditiontoantiplatelettherapy,themanagementofNSTEMIpatientsundergoingemergencyinterventionalsoinvolvesotheraspectssuchasrevascularizationstrategies,anticoagulationtherapy,andcardiacrehabilitation.Revascularizationstrategiessuchaspercutaneouscoronaryintervention(PCI)andcoronaryarterybypassgrafting(CABG)aimtorestorebloodflowtotheischemicmyocardiumandimproveclinicaloutcomes.

PCIisthepreferredrevascularizationstrategyinNSTEMIpatientswithhigh-riskfeaturessuchaspersistentorrecurrentangina,hemodynamicinstability,andpositivecardiacbiomarkers.Theuseofnewer-generationdrug-elutingstents(DES)hassignificantlyreducedtheincidenceofrestenosisandstentthrombosis,leadingtoimprovedlong-termoutcomes.However,DESimplantationisassociatedwithariskofstentthrombosisandbleedingcomplications,especiallyinpatientsreceivingdualantiplatelettherapy.

CABGisusuallyreservedforpatientswithmultivesseldisease,leftmaindisease,orpreviousCABGwhoarenotsuitableforPCI.CABGofferscompleterevascularizationofalldiseasedvesselsandmaybeassociatedwithimprovedsurvivalinselectedpatients.However,CABGisamoreinvasiveprocedurethanPCIandrequiresalongerhospitalstayandrecoveryperiod.

AnticoagulationtherapywithheparinoradirectoralanticoagulantisrecommendedinallNSTEMIpatientsundergoinginterventiontopreventthromboembolicevents.However,theoptimaldurationandintensityofanticoagulationtherapyremainunclearandmayvarydependingonindividualpatientcharacteristicsandtherevascularizationstrategyused.

CardiacrehabilitationisanimportantcomponentofthemanagementofNSTEMIpatientsundergoingintervention.Cardiacrehabilitationprogramsaimtoimprovecardiovascularfitness,reduceriskfactors,andenhancepsychologicalandsocialwell-being.ThebenefitsofcardiacrehabilitationhavebeenwellestablishedinseveralrandomizedcontrolledtrialsandguidelinesrecommenditsuseinallNSTEMIpatientsundergoingintervention.

Insummary,themanagementofNSTEMIpatientsundergoingemergencyinterventioninvolvesamultidisciplinaryapproachthatincludesantiplatelettherapy,revascularizationstrategies,anticoagulationtherapy,andcardiacrehabilitati