术前高负荷量氯吡格雷预防急诊冠脉介入术后不良事件的临床研究

Clinical study of pretreatment with high-loading dose of clopidogrel for preventing adverse events after acute percutaneous coronary interventions

目的观察术前高负荷剂量氯吡格雷预防急性冠脉综合征(ACS)患者急诊经皮冠状动脉介入(PCI)术后缺血事件的效果。方法急诊行PCI术的ACS患者120例,随机分为两组,每组60例,对照组PCI术前给予口服氯吡格雷300 mg,试验组PCI术前给予口服氯吡格雷600 mg,两组其他常规治疗相同。观察两组术后30 d内心血管事件和出血事件发生率。结果术后30 d,试验组死亡1例,无紧急靶血管血运重建、明确的支架内血栓形成及再发心肌梗死发生,临床心血管事件发生率为1.67%;对照组死亡1例,再发心肌梗死2例,明确的支架内血栓形成2例,紧急靶血管血运重建2例,临床心血管事件发生率为11.67%,试验组心血管事件发生率明显低于对照组(P<0.05);两组出血事件发生率差异无统计学意义(P>0.05)。结论急诊PCI术前给予高负荷剂量氯吡格雷,可显著减少术后30 d内心血管事件,并且出血事件发生率无明显增加。

Objective To observe the effect of pretreatment with high-loading dose of clopidogrel for preventing ischemic events after acute percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）.Methods One hundred and twenty patients who underwent acute PCI were randomly divided into two groups ,with 60 cases in each group.The control group was given oral clopidogrel at a dose of 300mg before PCI,while the experimental group was given oral clopidogrel at a dose of 600 mg.Both groups received the routine treatment additionally .The incidences of cardiovascular events and hemorrhagic events within 30 days after operation were observed.Results Thirty days after operation,there was one dead case in the experimental group,no emergent target-vessel revascularization, confirmed stent thrombosis and recurrent myocardial infarction occurred ,and the incidence of clinical cardiovascular event was 1.67%;There was one dead case ,two cases of recurrent myocardial infarction ,two cases of confirmed stent thrombosis and two cases of emergent target-vessel revascularization in the control group ,and the incidence of clinical cardiovascular events was 11.67%.The incidence of cardiovascular events in the experimental group was significantly lower than that in the control group （P〈0.05）.There was no significant difference in the incidence of hemorrhagic events between two groups （P 〉0.05）.Conclusion Pretreatment with high-loading dose of clopidogrel before acute PCI might significantly decrease the incidence of cardiovascular events within 30 days after PCI , and doesn′t increase the incidence of hemorrhagic events .