对比分析血栓弹力图指导下的替格瑞洛与氯吡格雷治疗急性冠脉综合征的临床疗效

Comparative analysis of the efficacy of tigril and clopidogrel for patients with acute coronary syndromes under the guidance of thrombelastography

目的对于急性冠脉综合征(ACS)患者,分别在血栓弹力图指导下应用替格瑞洛与氯吡格雷进行治疗,对比分析抗血小板作用及不良事件发生情况。方法选择ACS患者134例,随机分为对照组(67例)和治疗组(67例),均在血栓弹力图指导下进行抗血栓治疗。对照组患者给予阿司匹林联合氯吡格雷,治疗组应用阿司匹林联合联合替格瑞洛。应用血栓弹力图评估反应时间(R)、血凝块形成时间(K)和高凝图形,检测血小板聚集抑制率(PAI),并记录治疗期间不良事件发生率,跟踪观察一年,评估主要不良心脑血管事件发生率。结果治疗组R和K分别为(6.07±1.13)min和(3.20±0.87)min,高于对照组(5.11±0.92)min和(2.53±0.76)min,差异有统计学意义(P<0.05);治疗组高凝图形发生率为1.49%(1/67),低于对照组8.96%(6/67),差异有统计学意义(P<0.05);治疗组治疗3 d后和3个月后PAI分别为(27.14±1.80)%和(36.20±5.59)%,高于对照组(24.30±4.26)%和(31.15±6.13)%,差异有统计学意义(P<0.05);治疗组支架内血栓和心绞痛复发发生率为2.99%(2/67),低于对照组10.45%(7/67),差异有统计学意义(P<0.05);治疗组呼吸困难发生率为13.43%(9/67),高于对照组2.99%(2/67),差异有统计学意义(P<0.05);治疗组主要不良心脑血管事件发生率为2.99%(3/67),低于对照组为8.96%(6/67),差异具有统计学意义(P<0.05)。结论血栓弹力图指导下应用替格瑞洛治疗ACS患者,抗血小板作用更迅速、有效,抗血栓作用和预后均显著好于氯吡格雷,但治疗过程中增加了相关性呼吸困难的发生。

Objective To compare the efficacy of tigril and clopidogrel for patients with acute coronary syndromes under the guidance of thrombelastography. Methods 134 patients were randomly divided into control group（ 67 cases） and treatment group（ 67 cases）,all of them were treated with thymidine. The control group was treated with aspirin combined with clopidogrel. The treatment group was treated with aspirin Union for Gregory. The response time（ R）,Blood clot formation time（ K） and high coagulation graphics were assessed by thrombelastography.Platelet aggregation inhibition rate（ PAI） were detected and the incidence of adverse events during treatment were recorded,follow-up one year the incidence of major adverse cardiovascular and cerebrovascular events were assessed. Results R and K of the treatment group were（ 6. 07 ±1. 13） min and（ 3. 20 ± 0. 87） min respectively,significantly higher than those of the control group（ 5. 11 ± 0. 92） min and（ 2. 53 ± 0. 76） min,the difference was statistically significant（ P 〈 0. 05）. The incidence of hyperviscosity of the treatment group was 1. 49%（ 1/67）,lower than that of the control group 8. 96%（ 6/67）,the difference was statistically significant（ P 〈 0. 05）. PAI of the treatment group after 3d and 3month were（ 27. 14 ± 1. 80） % and（ 36. 20 ± 5. 59） % respectively,higher than those of the control group（ 24. 30 ± 4. 26） % and（ 31. 15 ± 6. 13） %,the difference was statistically significant（ P 〈 0. 05）. The incidence of thrombosis and angina pectoris of the treatment group was 2. 99%（ 2/67）,lower than that of the control group 10. 45%（ 7/67）,the difference was statistically significant（ P 〈 0. 05）. The incidence of dyspnea of the treatment group was 13. 43%（ 9/67）,higher than that of the control group 2. 99%（ 2/67）,the difference was statistically significant（ P 〈0. 05）. The incidence of major cardiovascular and cerebrovascular events of the treatment group was 2. 99%（ 3/67）,lower than that of the control group 8. 96%（ 6/67）,the difference was statistically significant（ P 〈 0. 05）. Conclusion The patients with ACS treated with troglithine under the guidance of thrombelastography,the anti-platelet effect more quickly and effective. The anti-thrombosis and prognosis were significantly better than clopidogrel,but the treatment process increased the occurrence of related dyspnea.