戒烟对急性心肌梗死患者阿司匹林与氯吡格雷抑制血小板功能的影响

Effects of Quit Smoking on Inhibition of Platelet Function by Aspirin and Clopidogrel in Patients with Acute Myocardial Infarction

目的探讨戒烟对急性心肌梗死(AMI)患者阿司匹林与氯吡格雷抑制血小板功能的影响。方法选取我院2014年1月至2016年1月期间收治的具有吸烟史的AMI患者90例,按来院治疗前是否戒烟分为观察组和对照组,每组45例,两组均给予静脉滴注尿激酶后嚼服氯吡格雷和口服阿司匹林治疗,观察组治疗前已戒烟≥1年,且治疗期间严谨吸烟;对照组治疗期间减少或不吸烟。比较两组患者血小板抑制率,比较两组再发心肌梗死率、血管再通率、再闭塞发生率及LVEF评估治疗效果。结果两组AA诱导的血小板抑制率、ADP诱导的血小板抑制率观察组均高于对照组(P<0.05);两组血管再通率差异无明显差异(P>0.05),观察组再发心肌梗死率2.22%、再闭塞发生率6.67%显著低于对照组13.33%、22.22%(P<0.05),治疗前两组LVEF差异无统计学意义(P>0.05),治疗后观察组LVEF(48.55±6.89)%显著高于对照组(P<0.01)。结论戒烟可显著提高AMI患者阿司匹林与氯吡格雷血小板抑制率,上调AMI治疗效果。

Objective To explore effects of quit smoking on inhibition of platelet function by aspirin and clopidogrel in patients with acute myocardial infarction （AMI）. Methods 90 AMI patients with a history of smoking treated in our hospital from January 2014 to January 2016 were selected, they were divided into the observation group and the control group according to whether they quitted smoking or not before admission,45 cases in each group, two groups were given chewing clopidogrel and aspirin orally after intravenous infusion urokinase, the observation group had quitted smoking ≥ 1 year before the treatment, and strict smoking was carried out during the treatment;the control group had not quitted smoking,reduced or no smorking during the treatment. The two groups were compared, including platelet inhibition rate, recurrent myocardial infarction rate, vascular patency rate, incidence of reocclusion and LVEF in the two groups were compared to estimate treatment effect. Results The platelet inhibition rate in AA induction and in ADP induction the observation group after the treatment were significantly higher than the control group （P 〈 0. 05 ） ;there was no significant difference in differences in vascular patency rates in the two groups （P 〉 0.05 ）, recurrent myocardial infarction rate in the observation group 2.22%, incidence of reocclusion 6.67% were significantly lower than the control group （13.33 % ,22.22% ）（P 〈 0. 05 ）, there was no significant difference in differences in LVEF in the two groups before the treatment（ P 〉 0. 05 ）, LVEF（48.55 ± 6. 89）% in the observation group after the treatment was significantly higher than the control group （P 〈 0.01 ）. Conclusion Quitting smoking can increase aspirin and clopidogrel platelet inhibition rate in AMI patients significantly, has a positive influence to treatment effect of AMI.