PCI术前应用高负荷量氯吡格雷近期疗效观察

Short-term efficacy of high-load clopidogrel before PCI

目的：观察高负荷量的氯吡格雷对拟行经皮冠状动脉介入术（ PCI ）治疗的患者的近期疗效和安全性。方法将144例接受冠状动脉介入术治疗的患者根据随机数字表法分为观察组和对照组。观察组于术前给予高负荷量氯吡格雷（600 mg）顿服，对照组给予常规300 mg顿服。分别检测两组服药前和服药后血小板最大凝集率（ MPAR），比较两组术后30 d内的主要临床心血管事件和出血事件的发生情况。结果观察组患者服药后2 h血小板最大聚集率即发生明显下降（ P﹤0.05）；服药4 h后，两组患者最大血小板聚集率均出现显著下降，与治疗前比较差异均有统计学意义（P均﹤0.05）。高剂量氯吡格雷治疗组患者缺血事件、再梗死和血栓形成等并发症的发生率显著低于对照组（ P﹤0.05）。结论 PCI患者术前服用高负荷剂量氯吡格雷较常规负荷剂量预治疗能更大程度抑制直接治疗后的早期血小板凝集情况。可显著改善临床预后，降低不良心血管事件的发生率，且并不增加出血风险，治疗安全有效。

Objective To observe the short-term efficacy and safety of high loading dose of clopidogrel on proposed percutaneous coronary intervention（ PCI）patients. Methods One hundred and forty-four patients undergoing coronary intervention were divided into observation group and control group,according to the random number table. Observation group was given preoperatively high load-ing dose of clopidogrel（ 600 mg ）,administered at draught;The control group received conventional 300 mg,administered at draught. Maximum platelet aggregation rate（ MPAR）before and after taking the medication was detected and compared,30 d postoperative clinical cardiovascular events and major bleeding events were observed. Results In the observation group,after taking 2 hours maximum platelet aggregation rate declined dramatically（P﹤0. 05）,after taking 4 h,maximum platelet aggregation rate of the two groups significantly declined. There were significant difference compared with that before treatment（P﹤0. 05）. Patients treated with high-dose clopidogrel had less ischemic events,reinfarction and thrombosis and other complications than the control group（ P ﹤0. 05 ）. Conclusions Compared with conventional pre-treatment,taking high loading dose of clopidogrel before PCI has a greater degree of direct inhibition of platelet aggregation at early stage. And can significantly improve clinical outcomes and reduce the incidence of adverse cardiovascular events,and does not increase the risk of bleeding,so the treatment is safe and effective.