氯吡格雷联合阿司匹林和低分子肝素治疗不稳定型心绞痛疗效和安全性观察

Clinical Efficacy and Safety of Consolidatory Therapy of Clopidogrel combined with Aspirin and Nadroparin Calcium in Patients with Unstable Pectoris

目的：观察氯吡格雷联合阿司匹林和低分子肝索治疗不稳定型心绞痛的临床疗效和安全性。方法：选取不稳定型心绞痛患者132例，随机分为两组。对照组65例，治疗采用口服肠溶阿司匹林片100mg，qd；低分子肝素钙注射液0．4～0．6mL皮下注射，q12h。强化治疗组67例，在对照组治疗基础上加用氯吡格雷75mg，qd。观察两组心绞痛症状、硝酸甘油日用量、静息心电图变化，并以难治性心绞痛、急性心肌梗死、死亡为观察终点。结果：治疗1周后，强化治疗组平均心绞痛发作次数为（1．8±5．0）次／周，对照组为（3．7±6．7）次／周；强化治疗组硝酸甘油日用量为（0．2±0．6）mg／d，对照组为（1．8±3．9）mg／d；强化治疗组心电图改善42例（62．7％），对照组心电图改善26例（40．0％）。两组比较，差异有显著性（P〈0．05或P〈0．01）。结论：氯吡格雷联合阿司匹林和低分子肝素治疗不稳定型心绞痛安全、有效，可降低难治性心绞痛发生的风险。

Objective：To investigate the clinical efficacy and safety of the consolidatory therapy of clopidogrel combined with Aspirin and Nadroparin calcium in patients with unstable angina pectoris. Methods： A total of 132 eligible patients were enrolled. They were divided into two groups randomizely. The control group was administered with Aspirin 100 mg once a day and Nadroparin calcium were be given subcutaneously twice daily（every 12 hours） with the dose of 0. 1 mL/10 kg. The consolidatory group was administered with clopidogrel 75 mg once a day in addition to aspirin and Nadroparin calcium. To observe the variety of symptoms, the daily dose of nitroglycerin and the electrocardiogram was given to patients with unstable angina. The endpoints included refractory angina pectoris, acute myocardial infarction, death. Results： The frequency of angina attacks in the consolidatory group was （1.8±5.0） a week. The frequency of angina attacks in the control group was （3.7±6.7） a week（P〈0.05）. The daily dose of nitroglycerin in the consoli- datory group was （0.2±0.6）mg/d. The daily dose of nitroglycerin in the control group was （1. 8±3.9） mg/d（P〈0.01）. Forty-two patients had improvements of electrocardiogram in the consolidatory group and the efficiency was 62. 7 %. Twenty-six patients had improvements of electrocardiogram in the control group, the efficiency was 40.0% （P〈0. 05 or P〈0.01）. Conclusion：The consolidatory therapy is effective and safe for patients with unstable angina pectoric. It may significantly lower the risk of refractory angina pectoris compared with traditional therapy.