比索洛尔对急性冠脉综合征患者急诊PCI术后QRS-T夹角的影响
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篇名: 比索洛尔对急性冠脉综合征患者急诊PCI术后QRS-T夹角的影响
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摘要: 目的:探讨比索洛尔对急性冠脉综合征(ACS)患者急诊经皮冠状动脉介入(PCI)术后QRS-T夹角的影响。方法:100例ACS并成功行PCI术患者随机分为常规组(50例)和比索洛尔组(50例),另同期选择50例冠脉狭窄<50%者作为对照组。常规组患者在PCI术前30 min给予阿司匹林肠溶片300 mg,口服,每日1次+硫酸氢氯吡格雷片600 mg,口服,每日1次,PCI术后当晚开始给予阿司匹林肠溶片100 mg,口服,每日1次+硫酸氢氯吡格雷片75 mg,口服,每日1次+阿托伐他汀钙片20 mg,口服,每日1次等常规治疗。比索洛尔组患者在常规组治疗的基础上加用富马酸比索洛尔片5 mg,口服,每日1次。对照组患者给予阿司匹林肠溶片+硫酸氢氯吡格雷片+阿托伐他汀钙片(用法用量均同常规组PCI术后)。各组均连续用药12个月。观察两组患者术前后QRS-T夹角并与对照组进行比较,记录Gensini积分,随访1年的主要不良事件(MACE)发生情况。结果:术后,比索洛尔组患者QRS-T夹角显著低于同组术前及常规组,但高于对照组,差异均有统计学意义(P<0.05);常规组患者术前后比较差异无统计学意义(P>0.05)。两组患者Gensini积分比较,差异无统计学意义(P>0.05)。比索洛尔组患者MACE发生率显著低于常规组,差异有统计学意义(P<0.05)。比索洛尔组患者(术前-术后)QRS-T夹角与MACE发生率呈负相关(r=-0.339,P=0.057),QRS-T夹角每增加1°,MACE风险降低8%(P=0.041);Gensini评分每增加1分,MACE发生风险升高32%(P=0.035)。结论:在常规治疗的基础上,ACS患者急诊PCI术后早期应用比索洛尔可降低QRS-T夹角及MACE的发生风险,且QRS-T夹角下降幅度与MACE的发生具有相关性。
ABSTRACT: OBJECTIVE: To investigate the effects of bisoprolol on the QRS-T angle in ACS patients after emergency PCI. METHODS: 100 ACS patients who took PCI were randomly divided into conventional group (50 cases) and bisoprolol group (50 cases), and other 50 coronary stenosis<50% were selected as control group. Patients in conventional group received Aspirin enteric-coated tablet 300 mg 30 min before PCI, orally, once a day+Clopidogrel bisulfate tablet 600 mg, orally, once a day, 100 mg aspirin was given in the night after PCI, orally, once a day+clopidogrel 75 mg, orally, once a day+Atorvastatin calcium tablet 20 mg, orally, once a day, and other conventional treatment. Bisoprolol group was additionally given Bisoprolol fumarate tablet 5 mg, orally, once a day. Control group received Aspirin enteric-coated tablet+Clopidogrel bisulfate tablet+Atorvastatin calcium tablet (the same dosage and usage as conventional group). All patients were treated for 12 months. The frontal QRS-T angle before and after operation, Gensini score in all groups the incidence of MACE in 1-year was followed-up. RESULTS: After operation, QRS-T angle in bisoprolol group was significantly lower than before and conventional group, but higher than control group, with statistical significances (P<0.05), there was no significant difference in conventional group before and after operation (P>0.05), so as the Gensini score in 2 groups (P>0.05). The incidence of MACE in bisoprolol group was significantly lower than conventional group, with statistical significance (P<0.05). The QRS-T angle in bisoprolol group(preoperative-postoperative) negatively correlated with the incidence of MACE (r=-0.339,P=0.057). MACE risk decreased 8% if frontal QRS-T angle increased 1° in bisoprolol group (P=0.041), MACE risk increased 32% if Gensini increased 1 score(P=0.035). CONCLUSIONS: Based on conventional treatment, early use of bisoprolol can reduce the QRS-T angle and the MACE risk, and the decrease degree of frontal QRS-T angle is correlated with the incidence of MACE.
期刊: 2016年第27卷第33期
作者: 叶沃若,王俊,刘书宇
AUTHORS: YE Woruo,WANG Jun,LIU Shuyu
关键字: 比索洛尔;急性冠脉综合征;经皮冠状动脉介入术;QRS-T夹角
KEYWORDS: Bisoprolol; ACS; PCI; QRS-T angle
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