老年冠心病患者长期双联抗血小板并消化道出血分析

Analysis of Long-term Dual Antiplatelet Therapy Combined Gastrointestinal Bleeding in Elderly Patients with Coronary Heart Disease

目的 探索老年冠心病患者长期双联抗血小板并消化道出血的可能性和临床危险性.方法 用数字法抽取2011-05～2013-05间在我院收治的老年冠心病患者86例,随机分为阿司匹林组和氢氯吡格雷片联合阿司匹林治疗的双联组,每组各43例.采集患者静脉血,分别测量两组患者服药前和服药后第3周、第8周、第12周的血小板聚集率（PAgT）、血小板计数（PLT）和凝血等3项,同时记录两组中出现消化道出血的例数.分析两组患者的相关数据.结果 阿司匹林组和双联组治疗后的PAgT较治疗前分别降低了0.07％和0.12％,PLT均下降了80×109/L（P＜0.05）,在治疗后这两个项目数据上不同时间均无显著差异（P＞0.05）.两组凝血酶原时间（PT）、部分凝血活酶时间（APTT）、血浆凝血酶时间（TT）和消化道出血率在治疗前后以及在治疗后的各个时期测量值未出现明显差异（P＞0.05）.结论 氢氯吡格雷片联合阿司匹林双联治疗老年冠心病有抗血小板的作用,对并发消化道出血的临床危险性不高,可以认为该联合治疗方法相对安全.

Objective To explore the possibility and clinical risk of coronary heart disease patients with long - term dual antiplatelet combined gastrointestinal bleeding. Methods 86 elderly patients with coronary heart disease were selected by digital method from May, 2011 to May, 2013 in the hospital were divided randomly into the Aspirin group （43 cases） and joint group combined clopidogrel tablets with aspirin （43 cases）. The vein blood of patients was collected. Platelet aggregation rate （PAgT）, platelet count （PLT） and blood coagulation before and after medication after three weeks, eight weeks and twelve weeks were mesured. Results After treatment, platelet aggre- gation rate were reduced by 0.07% and 0.12%, lower than those before therapy in group Aspirin and joint group; platelet counts were re- duced by 80 × 10-9/L and 80 × 10-9/L （P 〈0.05） ; there wasn＇t too much difference in the two projects on different time data （P 〉0.05） ; the prothrombin time （PT）, activated partial thromboplastin time （AFIT）, the original amount of fibrinogen （TT） and digestive tract hemorrhage rate at various times in the two groups were not obvious different before and after treatment （P 〉 0.05）. Conclusion It has the antiplatelet effect to treat senile coronary heart disease by clopidogrel tablets combined with aspirin, which is safe because of little clinical risk on gastrointestinal bleeding.