高维持量氯吡格雷在不稳定性心绞痛患者中的临床疗效及安全性  

Safety and efficacy of large maintenance dose of clopidogrel in patients with unstable angina pectoris

作　　者：王涛[1] 曾智[1] 陆东风[1] 曾昭华[1] 陆冬晓[1] 卜彤[1] 

机构地区：[1]广州医科大学附属第一医院,广州510120

出　　处：《右江医学》2014年第3期303-305,309,共4页Chinese Youjiang Medical Journal

摘　　要：目的观察高维持量氯吡格雷在不稳定性心绞痛患者中的临床疗效及安全性。方法将62例诊断明确的不稳定性心绞痛患者,随机分为治疗组(A组)和对照组(B组)。治疗组:常规抗心绞痛治疗,包括低盐低脂饮食,控制血压及血糖,口服硝酸酯药物、阿司匹林、β受体阻滞剂、他汀类药物,低分子肝素5000u皮下注射(2次/天,连用7天),就诊当天口服负荷剂量氯吡格雷300mg,次日起予氯吡格雷150mg/d维持。对照组:治疗次日起予氯吡格雷75mg/d维持治疗,余同治疗组。观察两组对心绞痛控制情况、心电图变化、有无出血等不良反应,评价其疗效及安全性,观察疗程为4周。结果治疗4周后,观察组与对照组的心绞痛发作次数分别为(1.4±0.6)次VS(3.8±1.1)次,心绞痛持续时间分别为(6.3±1.4)min VS(13.9±6.5)min,心电图提示观察组与对照组治疗有效率分别为(90.3%VS 64.5%),两两比较差异有统计学意义(P<0.05或<0.01),观察组与对照组的不良反应比较差异无统计学意义(P>0.05)。结论在不稳定性心绞痛患者治疗中,氯吡格雷150mg/d和75mg/d均为有效、安全的剂量,但高维持量的氯吡格雷更能明显改善患者的心肌缺血,且不增加出血风险。Objective To analyze the efficacy and safety of large maintenance dose of clopidogrel in patients with un- stable angina pectoris.Methods 62 cases diagnosed with unstable angina pectoris were randomly divided into treatment group （group A） and control group （group B）.All patients were treated with routine anti-anginal therapy as follows：low-salt and low-sugar diet, control of blood pressure and plasma glucose, oral administration of nitrates, aspirin,β blockers,statins,and subcutaneous injection of 5000 u of low molecule heparin by two times per day for 7 consecutive days.Based on the routine anti-anginal treatment, Group A were treated with 300 mg of clopidogrel on the diagnosis day and maintenance dose of clopidogrel with 150 mg/d from the next day, while Group B were treated with maintenance dose of clopidogrel with 75 mg per day from the next day.Then,angina control,changes in electrocardio- gram, with or without hematorrhea were observed, and the efficacy and safety were evaluated. Both groups were ob- served for 4 weeks.Results After four weeks of treatment,the angina attacks in Group A and Group B were （1.4±0.6） times and （3.8±1.1） times respectively,and their durations of angina were （6.3±1.4） and （13.9±6.5） rains re- spectively. The effective treatment ratios of Group A and Group B prompted by electrocardiogram were 90.3% and 64.5 % respectively and their differences were statistically significant（ p 〈0.05 or 〈0.01）. Differences of adverse reactions between groups were not statistically significant（ p〉0.05）.Conclusion Both 150 mg/d and 75 mg/d of clo- pidogrel were effective and safe in the treatment of patients with unstable angina pectoris, but large maintenance dose of it can more effectively improve the myocardial ischemia of patients without increasing risk of bleeding.

关 键 词：氯吡格雷 不稳定性心绞痛 ST段下移 

分 类 号：R541.4[医药卫生—心血管疾病]