阿司匹林联合小剂量氯吡格雷对PCI术后患者心肌保护及心血管不良事件的预防作用

Prevention of Postoperative PCI and Cardiovascular Adverse Events by Aspirin Combined with Low-dose Clopidogrel

目的探讨阿司匹林联合小剂量氯吡格雷对经皮冠脉介入手术(PCI)后患者心肌保护及心血管不良事件(MACE)的预防作用。方法选取我院2015年1月-2017年1月收治的拟实施PCI治疗的冠心病患者110例,采用随机数字表法分为联合组和对照组,各55例,联合组术前及术后服用阿司匹林联合小剂量氯吡格雷治疗,对照组仅采用阿司匹林治疗,对比两组治疗前后的肌酸激酶(CK)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)、P选择素(PS)水平、术后1年两组患者各类MACE的发生率、不良反应发生率。结果治疗前,两组患者的血清CK、AST、LDH、PS水平差异不具有统计学意义(P>0.05);治疗后,联合组的血清CK、AST、LDH、PS水平均显著低于对照组(P<0.05);治疗后,两组患者的血清CK、AST、LDH、PS水平较治疗前均显著降低(P<0.05);治疗后随访1年,联合组的MACE发生率为10.91%,显著低于对照组的25.45%,差异具有统计学意义(P<0.05);治疗过程中,联合组的不良反应发生率为10.91%,显著低于对照组的27.27%,差异具有统计学意义(P<0.05)。结论阿司匹林联合小剂量氯吡格雷在冠心病PCI手术患者中具有保护心肌、减少MACE发生率、降低不良反应的作用。

Objective To investigate the protective effects of aspirin combined with low-dose clopidogrel on patients with adverse cardiovascular events（ MACE） and myocardium after percutaneous coronary intervention（ PCI）. Methods A total of 110 patients with coronary heart disease who were scheduled to undergo PCI treatment between January 2015 and January 2017 were randomly divided into the combined group and the control group,with 55 cases in each. The combined group was treated with aspirin along with low-dose clopidogrel before and after surgery,while the control group was treated with aspirin alone. Levels of creatine kinase（ CK）,aspartate aminotransferase（ AST）,lactate dehydrogenase（ LDH）,and P-selectin（ PS） were compared between the two groups. The incidence of MACE and adverse reactions in the two groups one year after operation was also recorded. Results Before treatment,the difference in serum levels of CK,AST,LDH and PS between the two groups was not statistically significant（ P〈0.05）. After treatment,the serum levels of CK,AST,LDH and PS were significantly lower（ P〈0.05）,especially in the combined group. After one-year treatment,the incidence of MACE in the combined group was 10.91. %,significantly lower than 25.45% of the control group,and the difference was statistically significant（ P〈0.05）. During treatment,the incidence of adverse reactions in the combined group was 10.91%,which was significantly lower than 27.27% of the control group,so the difference was statistically significant（ P〈0.05）.Conclusion Aspirin combined with low-dose clopidogrel,when used in patients with coronary artery disease undergoing PCI,can help protect the myocardium,reduce the incidence of MACE and adverse reactions.