摘要
目的观察老年患者经皮冠状动脉介入治疗（PCI）术后氯吡格雷联合阿司匹林抗血小板治疗的有效性及安全性。方法对145例老年患者PCI术后进行1年的动态随访观察，所有患者均于PCI术前3d开始服用氯吡格雷，首剂300mg，以后75mg，每天1次，阿司匹林肠溶片0．1g，每天1次；术中均选择经桡动脉途径行冠状动脉支架置入术；术后低分子肝素5000U每12小时静脉滴注，连用3d；出院后双联抗血小板治疗1年。动态随访观察所有患者PCI术后1、3、6个月及1年时急性血栓、亚急性血栓、晚期血栓的发生率，术后主要心血管不良事件（MACE）包括心源性死亡、再次心肌梗死、再发心绞痛、继发心力衰竭及再次入院治疗，术后再狭窄及临床出血事件包括脑出血、消化道出血及皮下出血的情况。结果145例老年患者中多支病变56例，双支病变47例，单支病变42例，共置入支架225枚，所有患者手术顺利，随访期间出现消化道出血2例，牙龈及皮下瘀斑4例，无颅内出血，无心源性死亡，再发心绞痛5例。结论老年患者PCI围术期双联抗血小板治疗，尤其术后长期双抗治疗起到了显著的抗血小板作用，同时不良反应小，随访期间未出现急性冠状动脉事件，可改善老年患者的生活质量，临床使用安全可靠。
Objective To observe the efficacy and safety of clopidogrel combined with aspirin antiplatelet therapy in the treatment of elderly patients after PCI. Methods A total of 145 coronary heart disease （CHD）patients were followed up for one year after PCI, conventional preoperative preparation, clopidogrel and aspirin were prescribed for all CHD patients. The first dosage of clopidogrel was 300 mg, then 75 mg/d for one year. Aspirin 0. 1 g/d was taken for one year. Postoperative low molecular weight heparin 5000 U, q12 b, intravenous infusion, continuous use for 3 days, double antiplatelet therapy for 1 year after discharge. Acute thrombosis, subacute and late thrombosis incidence in all patients after PCI, 1, 3 and 6 months and 1 year were dynamicly followed-up. The events of acute-subacute and late throm- bosis in stent were observed. The bleeding events and vascular restenosis were also observed. Results There were 56 cases of multivessel disease, 47 cases of double vessel disease, 42 cases of single vessel disease. A total of 225 stents were applied. Subcutaneous ecchymosis gum in 4 cases, gastrointestinal bleeding in 2 cases, no intracranial hemorrhage, no heart deaths. Conclusions Perioperative dual anti-platelet therapy, especially after long-term double-antibody therapy in elderly patients with PCI, has sig-nificant anti-platelet effect and little side effects. During the follow-up period, there was no acute coro-nary events, it can improve the quality of life of elderly patients, the clinical use is safe and reliable.
出处
《中国实用医刊》
2013年第19期35-37,共3页
Chinese Journal of Practical Medicine
关键词
老年人
经皮冠状动脉介入治疗
双联抗血小板
治疗
Elderly patients
Percutaneous coronary intervention
Double antiplatelet therapy
Treatment
