术前负荷剂量波立维对急性心肌梗死经皮冠状动脉介入术的效果影响

Effects of preoperative load dose Plavix on PCI for acute myocardial infarction

目的探讨急性心肌梗死(AMI)患者行经皮冠状动脉介入术(PCI)术前应用不同负荷剂量波立维对手术效果的影响。方法选取2016年2月至2019年2月广东省普宁市普宁华侨医院62例拟行PCI术治疗的AMI患者,随机分为对照组30例和观察组32例。对照组在PCI手术前给予波立维300 mg负荷剂量预治疗,观察组于PCI术前给予波立维600 mg负荷剂量预治疗。分别于服用负荷剂量波立维前和服用后2、4、24 h时采集外周静脉血,测定两组患者血小板最大聚集率(MPAR);测定两组患者术前及术后7 d血清超敏C反应蛋白(hs-CRP)水平;记录两组随访期内主要心血管事件和出血事件。结果给药后,两组各时间点MPAR均较给药前显著降低,且观察组各时间点MPAR明显低于对照组(P<0.05);术后随访6个月内,观察组主要心血管事件发生率明显低于对照组(P<0.05),两组总出血发生率比较差异无统计学意义(P>0.05);给药后7 d,两组hs-CRP水平均较给药前降低,且观察组显著低于对照组(P<0.05)。结论PCI术前应用较高负荷剂量波立维能更有效地抑制血小板聚集,降低术后心血管事件发生率,且未明显增加出血事件发生率。

【Objective】To explore influences of different load doses of Plavix on surgical effect for patients with acute myocardial infarction(AMI)before percutaneous coronary intervention(PCI).【Methods】Sixty-two AMI patients who underwent elective PCI in the hospital from February 2016 to February 2019 were enrolled.They were randomly divided into control group(n=30)and observation group(n=32).Before PCI,control group was given pretreatment with 300 mg load dose of Plavix,while observation group was given 600 mg.Before and at 2,4 and 24 h after taking load dose of Plavix,peripheral venous blood was collected.The maximum platelet aggregation rate(MPAR)in both groups was measured.The level of serum hypersensitive Creactive protein(hs-CRP)in both groups before and at 7d after surgery was measured.The major cardiovascular events and bleeding events in both groups during follow-up were recorded.【Results】After administration,MPAR in both groups was significantly lower than that before administration.And MPAR of observation group was significantly lower than that of control group(P<0.05).Within 6-month follow-up,incidence of major cardiovascular events in observation group was significantly lower than that in control group(P<0.05).There was no significant difference in incidence of total bleeding between the two groups(P>0.05).At 7d after administration,hs-CRP level in both groups was lower than that before administration.And the level in observation group was significantly lower than that in control group(P<0.05).【Conclusion】The application of high-load dose of Plavix before PCI can inhibit platelet aggregation more effectively,and reduce incidence of postoperative cardiovascular events without significantly increasing incidence of bleeding events.