血栓弹力图对冠状动脉粥样硬化性心脏病经皮冠状动脉介入术后抗血小板治疗患者血小板聚集抑制效果的评价

Evaluation of thrombelastogram on the inhibitory effect of platelet aggregation in coronary heart disease patients with antiplatelet therapy after percutaneous coronary intervention

目的探讨血栓弹力图(TEG)对冠状动脉粥样硬化性心脏病(冠心病)经皮冠状动脉介入术(PCI)后抗血小板治疗患者血小板聚集抑制效果的评价。方法选择2017年1月至2018年12月我院收治的200例行PCI术后抗血小板治疗的冠心病患者作为研究对象,采用随机数表法分为对照组100例和观察组100例。对照组患者术前口服300 mg阿司匹林及300 mg硫酸氢氯吡格雷片,PCI术后口服100 mg阿司匹林,每日1次,75 mg氯吡格雷,每日1次。观察组患者术前口服300 mg阿司匹林及180 mg替格瑞洛口服,PCI术后口服100 mg阿司匹林,每日1次,90 mg替格瑞洛,每日1次,经TEG观察2组患者术后花生四烯酸(AA)及腺苷二磷酸(ADP)途径下凝血反应时间、血凝块形成时间、最大波幅及角度等TEG参数值及血小板聚集抑制效果。结果术后,观察组AA及ADP途径下凝血反应时间、血凝块形成时间长于对照组,最大波幅低于对照组,角度小于对照组,血小板抑制效果优于对照组,差异有统计学意义(P<0.05)。结论在TEG监测显示,阿司匹林联合替格瑞洛抗血小板聚集效果优于阿司匹林联合氯吡格雷,其可监测冠心病PCI术后抗血小板治疗患者血小板聚集抑制效果,利于临床监测结果指导调整抗血小板治疗方案,改善预后。

Objective To investigate the evaluation of thrombelastogram(TEG)on the inhibitory effect of platelet aggregation in coronary heart disease patients with antiplatelet therapy after percutaneous coronary intervention(PCI).Methods Two hundred coronary heart disease patients with antiplatelet therapy after PCI who admitted in the hospital from January 2017 to December 2018 were divided into two groups according to random number table,with 100 cases in each group.The patients in control group orally took 300 mg aspirin and 300 mg clopidogrel hydrogen sulfate tablets before surgery,and orally took 100 mg aspirin after PCI,1 time/d,75 mg clopidogrel,1 time/d.The patients in observa-tion group orally took 300 mg aspirin and 180 mg ticagrelor before surgery,and orally took 100 mg aspirin after PCI,1 time/d,90 mg ticagrelor,1 time/d.TEG was used to observe the TEG parameter values such as coagulation response time,blood clot formation time,maximum amplitude and angle under the AA and ADP pathways and the inhibitory effect of platelet aggregation in the two groups.Results After surgery,the coagulation response time and blood clot formation time under the AA and ADP pathways in observation group were longer than those in control group,the maximum amplitude of observation group was lower than that of control group,the maximum angle of observation group was smaller than that of control group,and the inhibitory effect of platelet in observation group was better than that in control group(P<0.05).Conclusion TEG monitoring shows that aspirin combined with ticagrelor has better antiplatelet aggregation effect than aspirin combined with clopidogrel.It can monitor the inhibitory effect of platelet aggregation in coronary heart disease patients with antiplatelet therapy after PCI,which is is helpful for the clinical monitoring results to guide the adjustment of antiplatelet treatment schemes and improve the prognosis.