阿司匹林2种给药方式治疗急性冠状动脉综合征的疗效比较  

COMPARISON OF TWO ASPIRIN USE WAYS IN PATIENTS WITH ACUTE CORONARY SYNDROME

作　　者：刘刚[1] 邓来林[1] 滑亚君[1] 

机构地区：[1]浙江省余姚市人民医院心内科,浙江余姚315400

出　　处：《河北医科大学学报》2012年第9期1000-1003,共4页Journal of Hebei Medical University

摘　　要：目的比较阿司匹林口服与经肛给药治疗急性冠状动脉综合征(acute coronary syndrome,ACS)急性期的临床效果,观察肛塞阿司匹林的不良后果及6个月临床事件,以便为ACS患者寻求一种口服用药的替代途径。方法符合不稳定型心绞痛和急性心肌梗死诊断标准患者120例,入院前均未口服阿司匹林及氯吡格雷。采用随机前瞻性对照研究,按随机区组设计方法将符合入选标准的患者随机分为2组,排除自动转院及失访者,最后肛塞(100mg/d)组52例,口服(100mg/d)组68例。对照组30例为无器质性心脏病及血液病,从未服用过阿司匹林及氯吡格雷的患者,分别采集ACS患者及对照组血标本,作相应处理,并测量相关数据。结果肛塞组二磷酸腺苷(adenosine diphosphate,ADP)诱导血小板聚集率降低幅度为(11.9±10.3)%,与口服组的(5.9±14.5)%比较差异无统计学意义(P>0.05);肛塞组花生四烯酸(rachidonic acid,AA)诱导血小板聚集率降低幅度为(11.8±10.4)%,与口服组的(6.1±14.6)%比较,差异无统计学意义(P>0.05)。肛塞组血小板CD62p水平降低幅度(10.8±18.5)%,与口服组的(9.1±11.9)%比较,差异无统计学意义(P>0.05)。随访6个月,肛塞组出现临床事件4例(7.69%),口服组出现临床事件5例(7.35%),2组间差异无统计学意义(P>0.05)。结论阿司匹林肛塞(100mg/d)与口服(100mg/d)途径在ACS急性期1周应用对ADP、AA诱导的血小板聚集率及血小板CD62p水平降低幅度的影响差异无统计学意义。肛塞用药可减少上消化道黏膜的直接刺激,可能替代不能口服阿司匹林的ACS患者的抗血小板治疗。ABSTRACT： Objective To compare the efficacy of transanal versus oral aspirin use in patients with acute coronary syndrome （ACS）, to observe the reaction and clinical events in 6 months of transanal aspirin use in ACS patients, in order to find an alternative to medication. Methods As a randomized prospective controlled study, a total of 120 ACS patients with unstable angina and acute myocardial infarction, who had never taken aspirin and clopidogrel before admission, were randomly treated with oral aspirin（ 100mg/d, OA, n = 68 ） and transanal spirin through the anus （ 100mg/d, TA, n = 52 ）, excluding the automatical transferred and the lost. Control group ： 30 cases of patients without structural heart disease and blood disease, had never taken aspirin and clopidogrel. Aspirin sensitivity was tested by optical platelet aggregation induced by adenosine diphosphate （ADP） and arachidonic acid （AA）. The serum CD62p contents were examined by flowcytometry. Results The lower amplitude of ADP - induced platelet aggregation rate in the transanal group was （ 11.9 ± 10.3 ） %, compared with the oral group （5.9 ±14.5 ） %, there was no statistically significant difference ; The lower amplitude of AA - induced platelet aggregation rate in the transanal group was （11.8 ± 10.4）%, compared with the oral group （6.1 ± 14.6 ）%, the difference was not statistically ignificant. The decreasing of platelet CD62p levels in the transanal group was （10.8 ± 18.5 ）%, and （9.1 ±11.9）% in the oral group, the difference was not statistically significant. After 6 - month follow - up, there were 4 cases of clinical events （7.69%） in the transanal group, and 5 cases （7.35%） in the oral group. There was no statistically significant difference. Conclusion For the ACS patients who take aspirin by any of the above two ways in the first week of the acute phase of ACS, there are no significant difference in the dcreasing level of the AA - induced platelet aggregation and platelet CD62p betwee

关 键 词：冠状动脉硬化 阿司匹林 投药 直肠 

分 类 号：R541[医药卫生—心血管疾病]