阿司匹林 氯吡格雷联合达比加群酯治疗冠心病合并房颤行PCI术患者临床疗效及血流变指标变化对照研究

A comparative study on the clinical efficacy and changes of homorheological indexes of aspirin and clopidogrel combined with dabigatran in patients with coronary heart disease complicated with atrial fibrillation after PCI

目的探讨阿司匹林、氯吡格雷联合达比加群酯胶囊治疗冠心病合并房颤行经皮冠状动脉介入术患者的临床效果及对血流变指标的影响.方法将98例行经皮冠状动脉介入术的冠心病台并房颤患者根据治疗方案不同分为观察组与对照组,每组49例,两组行经皮冠状动脉介入术后均口服阿司匹林、氯吡格雷治疗,观察组在上述治疗基础上加用进比加群酯胶囊治疗,观察6个月.治疗前后采用血流变分析仪检测两组血液流变学指标变化,指标包括全血比黏度、纤维蛋白原、血浆比黏度;比较两组栓塞事件发生率及再出血发生率,结果治疗6个月后,两组全血比黏度、纤维蛋白原、血浆比黏度水平均较治疗前显著下降(P<0.05或0.01),观察组均显著低于对照组(P<0.01);观察组栓塞事件发生率(4.1%)显著低于对照组(18.4%)(P<0.05),再出血发生率(18.4%)与对照组(14.3%)比较差异无统计学意义(P>0.05).结论冠心病合并房颤患者行经皮冠状动脉介入术后在阿司匹林及氯吡格雷治疗基础上予以达比加群酯胶囊治疗,能有效改善患者的血液流变学状况,减少血栓形成,不增加出血风险,安全性高.

Objective To analyze the clinical efficacy and changes of homorheological indexes of aspirin and clopidogrel combined with dabigatran in patients with coronary heart disease complicated with atrial fibrillation after PCI.Methods 98 patients with coronary heart disease and atrial fibrillation who underwent PCI were divided into observation group(n=49)and control group(n=49)according to different treatment options.Oral aspirin and clopidogrel were given to the control group,the observation group was given dabigatran capsule on the basis of the control group for 6 months.Hemorheology analyzer was used to detect changes in blood rheology indexes before and after treatment.The indicators included whole blood specific viscosity,fibrinogen,and plasma specific viscosity.The incidence of embolism and rebleeding were compared statistically between the two groups.Results After 6 months of treatment,the levels of whole blood specific viscosity,fibrinogen and plasma specific viscosity were significantly lower than those before treatment(P<0.05 or 0.01),and the observation group was significantly lower than the control group(P<0.01).The incidence of embolic events in the observation group(4.1%)was significantly lower than that in the control group(18.4%)(P<0.05).There was no significant difference in the incidence of rebleeding(18.4%)compared with the control group(14.3%)(P>0.05).Conclusions Patients with coronary heart disease complicated with atrial fibrillation treated with dabigatran capsules combined with aspirin and clopidogrel can effectively improve the hemorheology of patients,reduce thrombosis,increase the risk of bleeding,and have high safety.