早期应用氯吡格雷对急性心肌梗死溶栓治疗的影响  

EFFECT OF EARLY APPLICATION OF CLOPIDOGREL ON THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

作　　者：周长勇[1] 王其新[1] 顾华丽[1] 马先福[1] 徐万群[1] 于海初[1] 车志宏[1] 董静[1] 

机构地区：[1]青岛大学医学院附属医院急诊内科,山东青岛266003

出　　处：《齐鲁医学杂志》2006年第5期383-385,共3页Medical Journal of Qilu

摘　　要：目的观察在标准治疗的基础上早期应用氯吡格雷对急性心肌梗死溶栓治疗的影响。方法176例ST段抬高型急性心肌梗死病人随机分为标准组和联合组。两组均接受重组组织型纤溶酶原激活物（rt—PA）溶栓治疗。溶栓前两组均给予阿司匹林300mg口服，联合组加服氯吡格雷300mg。溶栓结束后两组均给予阿司匹林300mg，每天1次，3d后改为阿司匹林100mg，每天1次；联合组同时给予氯吡格雷75mg，每天1次。观察冠状动脉再通率及30d内再梗死率、梗死后心绞痛发生率及出血、急诊血运重建和心血管死亡事件。结果联合组冠状动脉再通率高于标准组，再梗死率、梗死后心绞痛发生率、急诊血运重建事件低于标准组，差别有显著性（X^2=3．98～4．44，P〈0．05）；总出血事件、心血管病死亡率两组无显著差别（P〉0．05）。结论溶栓时早期应用氯吡格雷可增加冠状动脉再通率，减少再梗死和梗死后心绞痛的发生，使急诊血运重建事件减少。Objective To observe the efficacy of clopidogrel on thrombolytic therapy in patients with acute myocardial infarction. Methods This study consisted of 176 patients with acute ST-segment elevation myocardial infarction who were randomly divided into standard group and combination group. The patients in both groups received recombinated tissue plasminogen activator （rt-PA） for thrombolysis. Before starting the thrombolysis, aspirin 300 mg daily, was given to all the patients, but clopidogrel,300 mg daily, was added to patients in the combination group only. After completion of the thrombolysis, aspirin, 300 mg daily, for three days, and then 100 mg daily for patients in both groups. Clopidogrel, 750 mg daily, was added to patients in the combination group. The recanalization of the coronary artery, reinfarction within 30 days, post-infarction angina pectoris, hemorrhage, urgent revascularization and cardiovascular death events were observed. Results The recanalization rate of the coronary artery was higher, while re-infarction rate, postinfarction angina pectoris rate, and emergency revascularization were lower in the combination group than the standard group （X^2= 3.98-4.44,P〈0.05）. The total hemorrhage and cardiovascular death events were of no significant difference between them （P〉0.05）. Conclusion An early application of clopidogrel in thrombolytic therapy may increase a recanalization rate of the coronary artery, and decrease the incidence of reinfarction, postinfarction angina pectoris, and emergency revascularization.

关 键 词：氯吡格雷 心肌梗死 血栓溶解疗法 阿司匹林 

分 类 号：R542.22[医药卫生—心血管疾病]