摘要
目的研究低分子肝素与氯吡格雷对不稳定性心绞痛(UAP)各危险层的疗效。方法采用Braunwald法对UAP的危险度分级,将84例UAP患者分为I级21人,Ⅱ级23人,III级40人。各组病人随机分为两组,治疗组予以低分子肝素治疗,疗程7天,对照组给予氯吡格雷治疗。所有患者均口服阿司匹林和单硝酸异山梨醇酯静脉滴注,直到控制胸痛为止。观察60天的终点事件(心源性死亡、心肌梗死、顽固性心绞痛)。结果对I级患者,终点事件无统计学差别,但在控制胸痛发作频率和持续时间上有差异(P<0.05),Ⅱ级患者在顽固性心绞痛事件上低分子肝素组发生率明显降低(P<0.05)。低分子肝素组对于Ⅲ级患者在心源性死亡、心肌梗死、顽固性心绞痛上发生率均低于氯吡格雷组(分别为P<0.01,P<0.01,P<0.001)。结论对不稳定心绞痛I级患者可以使用氯吡格雷控制患者心绞痛发作频率和持续时间,改善患者生活质量。对Ⅱ级、Ⅲ级患者,均需要予以低分子肝素强化治疗,以减少远期患者的急性心血管事件。
Objective To study the treatment effect of low molecular heparin and clopidogrel in patients with different classification risk of UAP. Methods According to Braunwald classification, 84 patients were divided into Ⅰ grade （21 cases）, Ⅱ grade（23 cases）, Ⅲ grade（40 cases）.Patients in every grade were divided into two group,test group were given low molecular heparin,control group were given clopidogrel.All the patients were given aspirin and isosorbide-5 mononitrat until the chest pain was controlled.Observed the end events such as cardiogenic death,myocardial infarction,intractable angina pectoris after 60 days. Resuits In Ⅰ grade,there was no difference in end events, but there was difference in chest pain and lasting time （P〈0.05）.In Ⅱ grade,intractable angina pectoris in test group was less than controll group （P〈0.05）.In Ⅲ grade,end events in test group were less than controll group（P〈0.01, P〈0.01, P〈0.001）.Conclusion Clopidogrel can decrease the chest pain in patients with UAP I grade. Patients with UAP Ⅱ , Ⅲ grade need to use low molecular heparin to decrease long term acute cardial events.
出处
《中国现代医药杂志》
2005年第3期21-23,共3页
Modern Medicine Journal of China
