目的 對(duì)比不同劑量替格瑞洛聯(lián)合美托洛爾緩釋片治療老年冠心病不穩(wěn)定心絞痛的效果。方法 2016年1月—2018年3月選擇在寶雞市中心醫(yī)院診治的老年冠心病不穩(wěn)定心絞痛患者136例，根據(jù)治療方法的不同分為觀察組80例與對(duì)照組56例。對(duì)照組給予口服美托洛爾緩釋片+大劑量替格瑞洛治療，觀察組給予口服美托洛爾緩釋片+小劑量替格瑞洛治療，兩組都用藥觀察4周。比較兩組臨床療效、心功能、炎癥因子水平及預(yù)后情況。結(jié)果 治療后觀察組與對(duì)照組的總有效率分別為96.3%和96.4%，兩組對(duì)比差異無統(tǒng)計(jì)學(xué)意義。兩組治療后的左心室射血分?jǐn)?shù)（LVEF）值高于治療前，左心室舒張末期半徑（LVEDD）值低于治療前，對(duì)比差異都有統(tǒng)計(jì)學(xué)意義（P<0.05），組間對(duì)比差異無統(tǒng)計(jì)學(xué)意義。兩組治療后的血清白介素-6（IL-6）和腫瘤壞死因子-α（TNF-α）都低于治療前，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；且觀察組也都顯著低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。隨訪6個(gè)月，觀察組的再發(fā)心絞痛、心肌梗死、冠脈再狹窄、心力衰竭等并發(fā)癥發(fā)生率（3.8%）顯著低于對(duì)照組（19.6%），差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論 小劑量替格瑞洛聯(lián)合美托洛爾緩釋片治療老年冠心病不穩(wěn)定心絞痛也能改善患者的心功能，提高治療效果，且能更加有效抑制炎癥因子的釋放，降低遠(yuǎn)期并發(fā)癥的發(fā)生。

Objective To compare the effects of different doses of ticagrelor combined with metoprolol sustained-release tablets in the treatment of unstable angina pectoris in elderly patients with coronary heart disease. Methods From January 2016 to March 2018, 136 elderly patients of coronary heart disease with unstable angina pectoris who were diagnosed and treated in a certain hospital were selected and were divided into the 80 patients in the observation group and 56 patients in the control group accorded to different treatment methods. The control group were given metoprolol sustained-release tablets+ high-dose ticagrelor treatment, the observation group were given metoprolol sustained-release tablets+ low-dose ticagrelor treatment, the two groups were observed for 4 weeks, the prognosis of the recorded and followed-up. Results The total effective rates of the observation group and the control group after treatment were 96.3% and 96.4%, respectively, there were no significant difference compared between the two groups. The LVEF values of the two groups after treatment were higher than those before treatment, and the LVEDD values were lower than those before treatment (P<0.05), there were no significant difference compared between the two groups. The serum IL-6 and TNF- α levels in the two groups after treatment were lower than those before treatment (P<0.05), and the observation group were also significantly lower than the control group (P<0.05). After 6 months of followed-up, the incidence of complications such as recurrent angina pectoris, myocardial infarction, coronary restenosis, and heart failure in the observation group (3.8%) were significantly lower than that in the control group (19.6%) (P<0.05). Conclusion Compares to the large doses, low-dose ticagrelor combined with metoprolol sustained-release tablets in the treatment of unstable coronary heart disease in elderly patients can improve the heart function, improve the therapeutic effect, and more effectively inhibit the release of inflammatory factors, it can reduce the occurrence of long-term complications.