应用血栓弹力图指导冠心病患者介入治疗术后抗血小板治疗的临床价值

Application of Thromboelastogram Guide the Interventional Therapy of Coronary Heart Disease Patients Postoperative Clinical Value of Antiplatelet Therapy

目的研究使用血栓弹力图(TEG)指导冠心病患者介入治疗(PCI)术后抗血小板治疗的临床价值。方法对我院心内科收治的240例院行PCI治疗且术后均采用TEG进行抗血小板治疗监制冠心病患者进行回顾性分析,分为80例急性心梗组(AMI)、80例不稳定型心绞痛(UAP)和80例稳定型心绞痛(SAP),在PCI术实行TEG检测方案和抗血小板治疗方案。结果 UAP组和SAP组的部分凝血活酶时间AMI组的值要高(P<0.05);SAP组的纤维蛋白原(Fbg)和D二聚体(D-D)比UAP组和AMI组明显要低(P<0.05);AMI、UAP和SAP组3组间在部分凝血活酶时间、Fbg、D-D比较,差异具有统计学意义(P<0.05);SAP组的反应时间和血凝块形成时间明显比AMI和UAP组时间长(P<0.05),SAP组的最大振幅和角度明显比AMI和UAP组要低(P<0.05);240例患者抗血小板药物反应低下(89例)在阿司匹林、氯吡格雷引诱的血小板抑制率比抗血小板反应正常(151例)明显要低(P<0.05)。结论在TEG表示中AMI和UAP组患者的血凝形态比SAP组患者要高,说明TEG能够作为冠心病术后引导抗凝治疗和疾病发展情况的检测,且更加适用于AMI和UAP组,其中患者的纤维蛋白原高对氯吡格雷敏感度低会增高患者的缺血发生率,依据TEG能有有效的检测血小板的聚集情况,指导临床上的降低Fbg的治疗,进而减少患者缺血事件的发生。

Objective To investigate the clinic value of thromboelastogram （TEG） guide the interventional（PCI） therapy of coronary heart disease patients postoperative clinical value of antiplatelet therapy. Methods 240 PCI patients treated by TEG in our hospital were selected and retrospectively analyzed. They were divided into acute myocardial infarction（AMI） group, Unstable angina pectoris（UAP） and stable angina pectoris （SAP）group, 80 cases in each group. They were given TEG detection project and antiplatelet elastic detection scheme. Results aPTT of UAP group and were higher than AMI group （P 〈 0. 05 ） ; fibrinogen and D- dimer of SAP group were lower than UAP group and AMI group （ P 〈 0. 05 ） ; the difference of aPTT, INR, fibrinogen and D-dimer of SAP between the three groups had statistic significance （P 〈 0. 05 ） ; response time and blood clot formation time of SAP group were longer than AMI group and UAP group （ P 〈 0. 05 ） , maximum amplitude and angle of SAP group were lower than AMI group and UAP group （ P 〈 0. 05） ; of 240 patients, antiplatelet drug reaction was lower （89 cases） , platelet inhibition ratio induced by aspirin, clopidogrel was lower than normal antiplatelet response （151 cases） （P 〈 0.05 ）. Conclusion In TEG, blood clot formation of AMI group and UAP group are higher than SAP group,it shows that, TEG can guide anticoagulant therapy and detect disease development of CHD, it is more suitable for AMI group and UAP group. Higher fibrinogen and lower clopidogrel sensitivity may increase ischemia occurrence rate, TEG can effectively detect platelet coagulation,lower fibrinogen and occurrence of ischemia event.