目的 探讨术前负荷量替格瑞洛对改善急性心肌梗死患者经皮冠脉介入（PCI）术后心肌灌注的作用。方法 选取2015年6月-2016年6月焦作市人民医院收治的PCI术后急性心肌梗死患者120例，随机分为对照组（60例）和治疗组（60例）。两组患者于PCI术前30 min嚼服阿司匹林片，0.3 g/次，对照组在此基础上嚼服硫酸氢氯吡格雷片，600 mg/次，治疗组在阿司匹林片基础上嚼服替格瑞洛片，180 mg/次。两组患者均于术中动脉鞘推注低分子肝素钠注射液1 000 U/kg，同时静脉持续泵入盐酸替罗非班注射液10 μg/L，持续24~36 h。两组患者PCI术1周后均长期皮下注射低分子肝素钠注射液5 000 U/次，对照组患者在此基础上长期口服阿司匹林片100 mg/d联合硫酸氢氯吡格雷片75 mg/d，治疗组在此基础上长期口服阿司匹林片100 mg/d联合替格瑞洛片90 mg/d。比较PCI前后两组患者心肌血流灌注指标、超声心动图指标、血清单核细胞趋化因子1（MCP-1）和高迁移率族蛋白1（HMGB1）水平以及主要心脏不良事件（MACE）发生率和不良反应率。结果 PCI术后，治疗组TIMI 3级57例、TMPG 3级54例，分别明显多于对照组的42例和40例，且治疗组无复流/慢血流比例显著低于对照组，两组比较差异具有统计学意义（P<0.05）。PCI术后，治疗组患者左室后壁厚度（LVPWT）、室间隔厚度（IVST）、左室舒张末内径（LVDd）水平明显降低，左心室射血分数（LVEF）水平升高，同组PCI术前后比较差异具有统计学意义（P<0.05）；且PCI术后治疗组超声心动图指标明显优于对照组（P<0.05）。PCI术后，两组患者血清MCP-1、HMGB1水平均显著降低（P<0.05）；且治疗组上述血清MCP-1、HMGB1水平明显低于对照组（P<0.05）。治疗组随访期间MACE发生率显著低于对照组，且治疗组MACE总发生率和不良反应总发生率明显低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 术前负荷应用替格瑞洛抗栓治疗能有效改善急性心肌梗死患者PCI术后心肌灌注及心功能，具有一定的临床推广应用价值。

Objective To investigate the effect of loading ticagrelor in treatment of myocardial perfusion of patients with acute myocardial infarction after PCI. Methods Patients (120 cases) with acute myocardial infarction after PCI in Jiaozuo People's Hospital from June 2015 to June 2016 were randomly divided into control (60 cases) and treatment (60 cases) groups. Patients in two groups were chewing administered with Aspirin Tablets 30 min before PCI. Patients in the control group were chewing administered with Clopidogrel Bisulfate Tablets based on Aspirin Tablets, 600 mg/time, patients in the treatment group were chewing administered with Ticagrelor Tablets on the basis of Aspirin Tablets, 180 mg/time. Patients in two groups were arterial sheath injection administered with Low Molecular Weight Heparin Sodium Injection in the surgery by 1 000 U/kg, at the same time they were continuous intravenous infusion administered with Tirofiban Hydrochloride Injection 10 μg/L for 24-36 h. Patients in two groups were long-term subcutaneous injection administered with Low Molecular Weight Heparin Sodium Injection 1 weeks after PCI, 5 000 U/time. on this basis, patients in the control group were long-term po administered with Aspirin Tablets by 100 mg/d and Clopidogrel Bisulfate Tablets by 75 mg/d. Patients in the treatment group were long-term po administered with Aspirin Tablets by 100 mg/d and Ticagrelor Tablets by 90 mg/d. Myocardial perfusion indexes, echocardiographic indicators, MCP-1 and HMGB1 levels, incidence of MACE and adverse reaction in two groups before and after PCI were compared. Results After PCI, TIMI grade 3 in the treatment group were 57 cases, TMPG grade 3 were 54 cases, which were significantly more than 42 cases and 40 cases in the control group, respectively, and the no reflow/slow flow in the treatment group was significantly lower than that in the control group, and there were differences between two groups (P<0.05). After PCI, the LVPWT, IVST and LVDd levels in two groups were significantly decreased, but the LVEF was significantly increased, and the difference was statistically significant in the same group (P<0.05). And the echocardiographic indicators in the treatment group were significantly better than those in the control group (P<0.05). After PCI, the MCP-1 and HMGB1 levels in two groups were significantly decreased (P<0.05). And the MCP-1 and HMGB1 in the treatment group was significantly lower than that in the control group (P<0.05). During follow-up, the incidence of MACE in the treatment group was significantly lower than that in the control group (P<0.05), and the total incidence of MACE and adverse reaction in the treatment group were significantly lower than those in the control group (P<0.05). Conclusion Picagrelor can effectively improve myocardial perfusion and cardiac function in treatment of patients with acute myocardial infarction after PCI, which has a certain clinical application value.