不同负荷量氯吡格雷联合瑞替普酶治疗急性心肌梗死的临床观察  

The Clinical Observation of Different Load of Clopidogrel Joint Reteplase at Treatment for Acute Myocardial Infarction

作　　者：李研[1] 唐彦[1] 裴建行[1] 

机构地区：[1]保定市第二中心医院,保定072750

出　　处：《血栓与止血学》2012年第3期108-111,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的探讨不同负荷剂量氯吡格雷联合瑞替普酶静脉溶栓治疗急性心肌梗死(acute myocardial infarc-tion,AMI)的疗效及安全性。方法将150例急性ST段抬高心肌梗死患者随机分为3组,所有患者均采用常规瑞替普酶静脉溶栓治疗。A组于溶栓前阿司匹林300 mg嚼服;在A组治疗的基础上,B组和C组患者分别于溶栓前顿服负荷量氯吡格雷300 mg或600 mg。比较3组间临床特征、溶栓血管再通率、再梗死率、梗死后心绞痛发生率、心源性猝死发生率、出血发生率的差异。结果 A组的溶栓再通率为40%,显著低于B组的62%和C组的72%,差异有统计学意义(P<0.05);B组的再通率略低于C组,但差异无统计学意义(P>0.05)。A组的溶栓后再梗死率26%、梗死后心绞痛发生率28%及心源性死亡率20%显著高于B组的6%、10%、4%和C组的4%、2%、2%,差异有统计学意义(P<0.05);而B组的溶栓后再梗死率、梗死后心绞痛发生率及心源性死亡率略高于C组,但差异无统计学意义(P>0.05)。A组、B组和C组的出血发生率依次为14%、16%和20%,组间比较其差异无显著统计学意义(P>0.05)。结论静脉溶栓前口服负荷量氯吡格雷能显著改善急性ST段抬高型心肌梗死患者的预后,降低不良事件发生率;这种受益随氯吡格雷负荷剂量的增加而增加,并且其安全性相当。Objective To explore the clinic curative effect and salty of the treatment to the patients with ST-elevation acute myocardial infarction （STEMI） , combinding different loading doses clopidogrel with reteplase. Method 150 cases of acute ST-elevation myocardial infarction patients were randomly divided into three groups, the patients of group A should take 300 mg aspirin before they were remedied with standard dose of reteplase. Besides the treatment of group A, the patients of group B and C should take different load of clopi- dogrel by 300 mg and 600 mg before the fibrinolytic therapy. Then we should contrast the three groups of the clinical characteristics, the rate of artery blood vessel recanalization, re- infarction, angina after infarction, car- diac sudden death and haemorrhage. Results In effect,the group A thrombolysis rate was 40% ,much lower than the 62% of group B and the 72% of C group, the difference was statistically significant （P 〈 0.05 ） ; the rate of group B is slightly below than that is of group C, but the difference was not statistically significant （ P 〉 0.05 ）. For group A, the rate of re-infarction, angina after infarction and cardiac sudden death was 26% ,28% and 20% ,which were significantly higher than the fate of group B（6% , 10% ,4% ） and the rate of group C （4% ,2% ,2% ）, the difference was statistically significant （P 〈 0.05 ）. And the rates of group B are slightly higher than which of the group C, but the difference was not statistically significant （ P 〉 0.05 ） o The bleeding rate of group A,group B and group C is in the incidence of 14% , 16% and 20% , compare the differences be- tween groups no significant statistically significant （P 〉 0.05 ）. Conclusion The combine treatment with clo- pidogrel, aspirin and reteplase on acute coronary syndrome can imp rove the clinical outcome, can be in effect to relieve complaint of STEMI and cn cut down the incidence of cardiac event, and the combine treatment is safe.

关 键 词：不同负荷剂量 氯吡格雷 瑞替普酶 急性ST段抬高心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]