氯吡格雷对ST段抬高型急性心肌梗死的长期疗效观察

Long-term effects of clopidogrel therapy on patients of acute myocardial infarction with ST-segement elevation

目的:观察溶栓治疗基础上联合氯吡格雷治疗ST段抬高型急性心肌梗死(STEAMI)的长期疗效及安全性。方法:将100例72h以内发病的未行冠状动脉介入治疗的STEAMI患者随机均分为2组。A组行标准治疗(即静脉溶栓、抗凝、降脂、减轻心脏氧耗等),B组患者在A组治疗基础上入院即刻给予氯吡格雷300mg口服,继之75mg/d,治疗1年。观察梗死后心绞痛发作及死亡、再发心肌梗死或脑卒中的联合终点。结果:与A组相比,B组患者梗死后心绞痛发作明显减少,死亡、再发心肌梗死或脑卒中的联合终点也有显著下降,2组比较差异有统计学意义,P<0.05;2组均无主要和次要出血事件发生,轻微出血发生率2组比较差异无统计学意义(P>0.05)。结论:STEAMI患者在溶栓治疗的基础上早期加用氯吡格雷300mg负荷量,继之75mg/d口服,治疗1年,可显著降低梗死后心绞痛的发作及死亡、再发心肌梗死或脑卒中的联合终点,且安全耐受性好。

Objective： To observe the long-term effects and safety of clopidogrel combined with standard therapy on patients of acute myocardial infarction with ST-segement elevation（STEAMI）. Method：One hundred patients with STEMI within 72 hours were divided into two groups randomly. All of them received were thrombolysis therapy. The patients in group B were treated with clopidogrel 300 mg immediately when they came to the hospital, and then were treated with clopidogrel 75 mg daily for 1 year. The attacks of postinfarction angina pectoris, events of heart failure and the composite of death, reinfarction or stroke were observed. Result：Compared with group A, patients of group B had obvious reduction in the attacks of postinfarction angina pectoris and the composite of death, reinfarction or stroke , P〈0.05. There were no events of major and minor bleeding in both groups, and the incidence rate of light bleeding had no statistics deviation. Conclusion.. Patients with STEAMI received the therapy of thrombolysis combined with clopidogrel 300 mg loading dose at first, then 75 mg once daily for one year could have hower insidence of the attacks of postinfarction angina pectoris and composite of death, reinfarction or stroke significantly.