氯吡格雷对急性前壁性心肌梗死患者PCI的疗效及安全性分析

Efficacy and safety of clopidogrel in the treatment of PCI in patients with acute anterior myocardial infarction

目的:探讨氯吡格雷在急性前壁性心肌梗死患者行经皮冠脉介入术(PCI)中应用的效果及安全性。方法:选取2013年1月~2015年1月本院收治的80例急性前壁性心肌梗死并行PCI手术患者,采用随机数字表法分为A、B组各40例,患者入院后首次均给予负荷剂量的氢氯吡格雷600 mg,之后A组给予氢氯吡格雷150 mg·d^(-1)、B组给予75 mg·d^(-1),两组其余治疗相同,氢氯吡格雷维持治疗至PCI术后6个月。结果:入院时,血小板聚集率、血清B型脑钠肽(BNP)比较,A、B两组患者差异不显著(P>0.05);术前及术后3个月,两组患者的血小板聚集率、血清BNP较入院时均显著的降低(P<0.05);术前及术后3个月,A组患者的血小板聚集率、血清BNP显著的低于B组患者(P<0.05);PCI术后,A组TIMI血流分级3级的患者有90%,高于B组患者的80.00%,但差异无统计学意义(P>0.05);术后12个月内,A组患者共有5例(12.50%)患者发生心血管不良事件,与B组的4例(10.00%)差异均无统计学意义(χ~2=0.125,P>0.05)。结论:高维持剂量的氢氯吡格雷在急性前壁性心肌梗死患者行PCI中应用具有降低血小板聚集率和降低BNP的作用,同时并不会增加心血管不良事件的发生率。

Objective： To evaluate the efficacy and safety of clopidogrel in patients with acute anterior wall myocardial infarction undergoing PCI. Methods： Selected January 2013 to January 2015,80 patients with acute anterior myocardial infarction were enrolled in this study. Using random number table method they were divided into A,B group,40 cases in each,After the first dose of clopidogrel 600 mg,group A was given clopidogrel 150 mg·d^-1,group B was given 75 mg·d^-1,the remaining treatment of the two groups was the same,lasting for 6 months after PCI. Results： There were no significant differences in platelet aggregation rate and serum BNP between the two groups（ P〉0. 05）. The platelet aggregation rate and serum BNP of the two groups were significantly lower than those of the two groups（ P〈0. 05）. The platelet aggregation rate,serum BNP was significantly lower than that of group B（ P〈0. 05）. After PCI,90% of patients with TIMI grade 3 were significantly higher in group A than 80. 00% in group B,but the difference was not statistically significant（ P〈0. 05）. Within 12 months after the operation,there were 5 patients（ 12. 50%） with adverse cardiovascular events in group A,wheras 4 patients（ 10%） in group B,thus there was no significant difference between group A and group B（ χ^2= 0. 125,P〉0. 05）. Conclusion： The use of clopidogrel at a high level in patients with acute anterior wall myocardial infarction with PCI reduces the platelet aggregation rate and decreases BNP,and does not increase the incidence of adverse cardiovascular events.