摘要
目的研究老年高危急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)前应用600mg高负荷剂量氯吡格雷的有效性和安全性。方法选取2005年12月—2008年12月96例住院的老年高危ACS患者,随机分为氯吡格雷高负荷剂量组(600mg)和常规剂量组(300mg),PCI术前给药,其他常规治疗不变。比较两组患者PCI术后即刻罪犯血管(CV)的TIMI血流分级;术前、术后24h二磷酸腺苷(ADP)诱导的血小板聚集率(PA);血小板计数(PTL);术后6、12h的肌酸激酶同工酶(CK-MB)的水平;以及术后30d内主要不良心脏事件(MACE)的发生率;术后出血的发生率。结果高负荷剂量组和常规剂量组罪犯血管术后即刻的TIMI血流分级(计帧法)分别为(35.5±6.1)%和(38.7±8.2)%,差异有统计学意义(P<0.05);两组术后24hPA(%)分别为(17.5±7.6)%和(18.3±10.5)%,差异有统计学意义(P<0.05);两组术后24hPTL(×106/mm3)分别为(159.0±48.3)和(186.2±67.0),差异有统计学意义(P<0.05);两组术后6及12hCK-MB(mmol/L)分别为:(16.2±3.9)、(13.4±3.9)和(18.4±4.8)、(15.5±5.1),差异有统计学意义(P<0.05);两组术后30dMACE的发生率以及术后出血的发生率差异无统计学意义(P>0.05)。结论老年高危ACS患者介入治疗前应用600mg高负荷剂量氯吡格雷是安全、有效的,且疗效优于常规剂量。
Objective To study the efficacy and safety of high-loading-dose （HLD） clopidogrel for elderly high-risk patients with acute coronary syndrome （ACS） under going percutaneous coronary intervention （PCI）.Methods Totally 96 consecutive cases of hospitalized elderly high-risk patients with ACS from December 2005 to December 2008 were randomly divided into HLD group （600 mg） and conventional dose （CD） group （300 mg） based on the dosage of clopidogrel.Drugs were given before PCI.The TIMI flow grade of crime vascular （CV） after PCI,rates of ADP-induced platelet aggregation （PA） before PCI and 24 hours after PCI,platelet count （PTL）,6-and 12-hour creatine kinase isoenzyme （CK-MB） levels,major adverse cardiac events （MACE） within 30 days,and post-operative bleeding rates were recorded and compared between the two groups.Results The immediate TIMI flow grade （by frames） after PCI were （35.5 ± 6.1） % and （38.7 ± 8.2）% in HLD group and CD group,respectively （P〈0.05）.The post-operative 24-hour PA rates after PCI were （17.5±7.6 ）% and （18.3±10.5 ）%,respectively （P〈0.05）.The post-operative 24-hour PTLs were （159.0± 48.3 ）× 10^6/mm^3and （186.2 ± 67.0）× 10^6/mm^3respectively （P〈0.05）.The post-operative 6-and 12-hour CK-MB levels were （16.2±3.9） mmol/L and （13.4 ± 3.9） mmol/L in HLD group and （18.4 ± 4.8） mmol/L and （15.5 ± 5.1） mmol/L in CD group （P〉0.05）.MACE rates within 30 days after PCI and post-operative bleeding rates were not significantly different between these two groups.Conclusion HLD clopidogrel （600 mg） is safe and effective for elderly high-risk patients with ACS undergoing PCI.
出处
《中国全科医学》
CAS
CSCD
北大核心
2010年第9期917-919,共3页
Chinese General Practice
