大剂量氯吡格雷对选择性经皮冠状动脉介入术的影响

Affection for selective percutaneous coronary intervention with high dose clopidogrel

目的 研究大剂量氯吡格雷用于选择性经皮冠脉介入治疗（PCI）患者的疗效及安全性.方法 确诊冠心病并接受择期PCI的患者173例,分成氯吡格雷强化组（波立维600 mg,87例）和氯吡格雷标准组 （波立维300 mg,86例）.PCI治疗前两组患者分别给予波立维600 mg和波立维300 mg治疗;PCI术后每日分别给予150 mg和75 mg,共 7 d;以后均服用波立维75 mg至1年以上.观察两组患者的疗效及不良反应的发生情况.结果 氯吡格雷强化组和氯吡咯雷标准组达到的完全血运重建率分别为93.8% 和 87.2%（P＜0.05）;两组主要不良心脑血管事件（MACCE）发生率分别为2.0%和6.8%,差异均有统计学意义（P＜0.01）;而出血和血管并发症的发生率差异无统计学意义（1.6%比1.7%,P＞0.05）.结论 氯吡格雷强化组PCI的疗效和安全性均优于氯吡格雷标准组.

Objective To study therapeutic efficacy and safety of high dose clopidogrel in patients with coronary heart diseases （CHD） who underwent selective percutaneous coronary intervention（PCI）. Methods A to-tal of 173 CHD patients underwent PCI were divided into strong clopidogrel group （received 600 mg of plavix, n=87） and standard clopidogrel group （received 300 mg of plavix, n=86）. Before PCI, the two groups were respec-tively given 600 mg and 300 mg of plavix. They were respectively given 150 and 75 mg every day for 7 days after PCI. Then they were all given 75 mg every day over one year. Therapeutic efficacy and occurrence of adverse reac-tions were observed in the two groups. Results There were significant difference in complete revascularization rate （93.8% vs 87.2%, P〈0.05）, major adverse cardiovascular-cerebral events （MACCE）（2.0% vs 6.8%,P〈0.01）. There were no differences in bleeding and vascular complications （1.6% vs 1.7%, P〉0.05 ） between strong clopi-dogrel group and standard clopidogrel group. Conclusion Strong clopidogrel is more effective and safe than stan-dard clopidogrel in selective PCI of CHD.