标题：替格瑞洛联合依诺肝素治疗急性冠脉综合征的疗效及对患者心功能、外周血管内皮功能及Gensini评分的影响

      作者：屈文静 1，李倩 2    延安市人民医院急诊科 1、心血管内科 2，陕西 延安 716000

      卷次： 2021年32卷23期

      【摘要】 目的 观察替格瑞洛联合依诺肝素治疗急性冠状动脉综合征(ACS)的疗效，并探讨其对患者心功能、外周血管内皮功能及Gensini评分的影响。方法 选取延安市人民医院于2019年8月至2020年10月期间收治的100例老年ACS患者为研究对象，按照随机数表法分为对照组和观察组，每组50例。两组患者均行常规治疗，其中对照组采用阿司匹林+依诺肝素治疗，观察组在对照组治疗的基础上采用替格瑞洛治疗，两组疗程均为两周。疗程结束后比较两组患者的治疗效果，以及外周血管内皮功能、心功能、凝血功能和Gensini评分，并统计两组患者的心血管不良事件发生情况。结果 观察组患者的治疗总有效率为94.0%，明显高于对照组的80.0%，差异有统计学意义(P<0.05)；治疗两周后，观察组患者的左室射血分数(LVEF)、每搏量(SV)以及 6 min 步行距离分别为(44.79±4.38)%、(46.48±4.38) mL、(416.64±38.89) m，明显高于对照组的(41.68±4.72)%、(42.73±4.59) mL、(377.78±35.23) m，左心室舒张末期内径(LVEDD)、左室收缩末内径(LVESD)及Gensini评分分别为(49.85±4.68) mm、(41.65±4.84) mm、(34.65±4.79)分，明显低于对照组的(54.45±5.35) mm、(45.34±5.39) mm、(45.78±5.46)分，差异均有统计学意义(P<0.05)；治疗2周后，观察组患者的纤维蛋白原(FIB)、D-二聚体(D-D)、纤溶酶原激活剂抑制因子(PAI-1)、内皮素1水平分别为(2.32±0.45) g/L、(0.75±0.26) mg/L、(38.76±4.25) μg/L、(47.78±13.26) ng/L，明显低于对照组的(2.87±0.53) g/L、(1.02±0.36) mg/L、(46.97±6.38) μg/L、(59.69±16.29) ng/L；组织型纤溶酶原激活剂(t-PA)、一氧化氮(NO)、血管反应性充血指数(RHI)水平分别为(18.68±3.47) μg/L、(80.45±8.12) μmol/L、(1.39±0.27) mmol/L，明显高于对照组的(16.87±3.50) μg/L、(75.39±7.28) μmol/L、(1.28±0.25) mmol/L，差异均有统计学意义(P<0.05)；两组患者的主要心血管事件总发生率比较差异无统计学意义(P>0.05)。结论 替格瑞洛联合依诺肝素治疗ACS效果显著，其可有效改善患者的心功能、外周血管内皮功能以及凝血状态，降低Gensini评分，安全性高。
      【关键词】 替格瑞洛；依诺肝素；急性冠脉综合征；心功能；内皮功能；Gensini评分
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2021）23—3019—05

Effect of tigelorelor combined with enoxaparin in the treatment of acute coronary syndrome and its effect oncardiac function, skin function in peripheral blood and Gensini score.
QU Wen-jing 1, LI Qian 2. Department ofEmergency 1, Cardiovascular Department 2, Yan'an People's Hospital, Yan'an 716000, Shaanxi, CHINA
【Abstract】 Objective To observe the efficacy of ticagrelor combined with enoxaparin in the treatment of acutecoronary syndrome (ACS), and to explore its effect on patients' cardiac function, peripheral vascular endothelial functionand Gensini score. Methods A total of 100 elderly ACS patients, who admitted to Yan'an People's Hospital between Au-gust 2019 and October 2020, were selected and divided into the control group and the observation group according torandom table number method, with 50 cases in each group. Both groups were treated with routine treatment, the controlgroup was treated with aspirin and enoxaparin, and the observation group was treated with tigelorelor on the basis of thecontrol group. The treatment effects of the two groups of patients, as well as peripheral vascular endothelial function, car-diac function, coagulation function and Gensini score were compared, and the cardiovascular adverse events of the twogroups of patients were counted. Results The total effective rate of treatment in the observation group was 94.0% ,which was significantly higher than 80.0% in the control group, and the difference was statistically significant (P<0.05).After 2 weeks of treatment, the left ventricular ejection fraction (LVEF), stroke volume (SV), and 6-min walking dis-tance of the observation group were (44.79±4.38)%, (46.48±4.38) mL, (416.64±38.89) m, respectively, which were sig-nificantly higher than corresponding (41.68±4.72)%, (42.73±4.59) mL, (377.78±35.23) m of the control group (all P<0.05); the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and Gensiniscores of the observation group were (49.85±4.68) mm, (41.65±4.84) mm, (34.65±4.79) points, respectively, which weresignificantly lower than corresponding (54.45±5.35) mm, (45.34±5.39) mm, (5.78±5.46) points of the control group (allP<0.05). After 2 weeks of treatment, the levels of fibrinogen (FIB), D-Dimer (D-D), plasminogen activator inhibitor-1(PAI-1) and endothelin-1 in the observation group were (2.32±0.45) g/L, (0.75±0.26) mg/L, (38.76±4.25) μg/L, (47.78±