高负荷剂量氯吡格雷对直接经皮冠状动脉介入患者心肌灌注的影响

Effects of high loading dose of clopidogrel on myocardial perfusion in patients with percutaneous coronary intervention

目的 探讨高负荷剂量氯吡格雷对直接经皮冠状动脉介入患者心肌灌注的影响.方法 收集自2009年2月至2014年2月接受经皮冠状动脉介入心肌灌注的病例80例,随机分为对照组40例（术前6h顿服300 mg氯吡格雷）和实验组40例（术前6h顿服600 mg氯吡格雷）.结果 对照组心脏损伤血清标记物各项指标：血清肌酸肌酶水平（CK） （96.8±16.2）IU/ml,血清肌酸肌酶同工酶水平（CK-MB） （9.9±2.7）IU/ml,和肌钙蛋白水平T（CTnT）（1.6±0.5）mg/ml.实验组CK （45.7±8.1）IU/mL,CK-MB（6.5±1.6） IU/mL,T （CTnT）（1.0±0.1） mg/ml;对照组凝血功能指标：凝血酶原时间（PT）（11.8±2.2）s,活化部分凝血活酶时间（APTT）（37.6±4.0）s,和血小板计数（PLT）（225.8±23.5）×109/L.实验组PT （13.5±3.4）s,APTT（39.6±3.9）s,PLT（189.3±21.5）×109/L;对照组事件不良事件发生总率为28％,病死率为6％.实验组不良事件发生总率为10％,病死率为2％.结果显示实验组临床效果优于对照组,P ＜0.05,差异有统计学意义.结论 实行冠脉介入术PCI的患者中实验组比对照组更好地抑制了血小板凝集,临床预后有所改善,可考虑临床中广泛推广.

Objective To investigate the effects of high loading dose of clopidogrel for myocardial perfusionin on patients with percutaneous coronary intervention.Methods Eighty cases of patients underwent percutaneous coronary intervention myocardial perfusion in our hospital from February 2009 to February 2014 were selected and randomly divided into control group （serving dayton 300 mg clopidogrel six hours before surgery） of 40 cases and the experimental group （serving dayton 600 mg clopidogrel six hours before surgery）of 40 cases.Results Serum markers of heart damage indicators in control group were：serum creatine kinase levels （CK） was （96.8 ± 16.2） IU/ml,serum levels of creatine kinase isoenzyme （CK-MB） was （9.9 ± 2.7） IU/ml,and troponin level T （CTnT） was（1.6 ± 0.5） mg/ml.In experimental group,CK was （45.7 ± 8.1） IU/ml,CK-MB was （6.5 ± 1.6） IU/ml,T （CTnT） was （1.0 ± 0.1） mg/ml.Coagulation parameters in control group：prothrombin time （PT） was （11.8 ± 2.2）s,activated partial thromboplastin live enzymes time （APTT）was（37.6 ± 4.0）s,and platelet count （PLT） was （225.8 ± 23.5） × 109/L.In experimental group,PT was （13.5 ± 3.4） s,APTT was （39.6 ±3.9）s,PLT was（189.3 ±21.5） × 109/L.Adverse events incidence in the control group was 28％ and the fatality rate was 6％.Adverse events incidence in the experimental group was 10％ and the fatality rate was 2％.The results showed that the clinical effect of the experimental group were better than that of the control group,and there was significant difference （P ＜ O.05）.Conclusions Implementation of PCI in patients with coronary intervention in the experimental group better inhibits platelet aggregation than the control group,and can improve clinical outcomes,so it can be considered clinically widely.