阿司匹林和氯吡格雷分别用于冠状动脉内膜剥脱并冠状动脉搭桥术后血管再狭窄的预防效果和安全性比较  

Comparison of Preventive Effects and Safety of Aspirin and Clopidogrel Respectively Used for Vascular Restenosis after Coronary Intimal Stripping with Coronary Artery Bypass Grafting

作　　者：吴联合[1] 王砚池 张申[1] 孟鲁豫 张正升[1] 米怀雪 

机构地区：[1]济宁市第一人民医院心外科一病区,山东济宁272000

出　　处：《中国药房》2017年第6期762-765,共4页China Pharmacy

摘　　要：目的:比较阿司匹林和氯吡格雷分别用于冠状动脉内膜剥脱并冠状动脉搭桥术后血管再狭窄的预防效果和安全性。方法:110例冠状动脉粥样硬化性心脏疾病患者随机分为阿司匹林组(55例)和氯吡格雷组(55例)。两组患者冠状动脉内膜剥脱并冠状动脉搭桥术后均静脉微泵硝酸甘油注射液10 mg+5%葡萄糖注射液共20 m L维持48~72 h,必要时静脉泵入盐酸多巴胺注射液1~5μg/kg。术后拔除气管插管,给予注射用头孢呋辛钠1.5 g加入灭菌注射用水50 m L,静脉滴注,每日3次,连用2~3 d。同时,每日晚饭后30 min口服瑞舒伐他汀钙片10 mg,8周为1个疗程,连用3个疗程。在此基础上,阿司匹林组患者给予阿司匹林肠溶片首次负荷剂量300 mg,口服,每日1次,第2日起口服100 mg,每日1次,连用6个月;氯吡格雷组给予硫酸氢氯吡格雷片首次负荷剂量300 mg,每日1次,第2日起口服75 mg,每日1次,连用6个月。观察两组患者的桥血管通畅率,治疗前后血小板聚集率、血小板聚集达标率、纤维蛋白原(Fg)、D-二聚体(D-D)、血小板计数(PLT)、组织型纤溶酶原激活物(t-PA)水平及不良反应发生情况。结果:两组患者桥血管通畅率、不良反应发生率比较,差异均无统计学意义(P>0.05)。治疗前,两组患者血小板聚集率、血小板聚集达标率、Fg、D-D、PLT、t-PA水平比较,差异均无统计学意义(P>0.05)。治疗后,两组患者血小板聚集率、Fg、D-D水平均显著低于同组治疗前,血小板聚集达标率、PLT、t-PA水平均显著高于同组治疗前,差异均有统计学意义(P<0.05),但两组间比较差异均无统计学意义(P>0.05)。结论:在常规治疗的基础上,阿司匹林、氯吡格雷用于冠状动脉内膜剥脱并冠状动脉搭桥术后,均可抑制血小板聚集,减少血栓形成,维持桥血管通畅,预防血管再狭窄,且安全性均较好。OBJECTIVE：To compare the preventive effects and safety of aspirin and clopodogrel respectively used for vascular restenosis after coronary intimal striping with coronary artery bypass grafting. METHODS：110 patients with coronary atherosclerotic heart disease were divided into aspirin group（55 cases） and clopodogrel group（55 cases）. All patients intravenously micro-pumped Nitroglycerin injection 10 mg＋5% Glucose injection totally 20 m L for maintaining 48-72 h after coronary intimal striping with coronary artery bypass grafting,intravenously pumped Dopamine hydrochloride injection 1-5 μ g/kg if necessary. Unplug the endotracheal tube after surgery,patients received Cefuroxime sodium for injection 1.5 g adding into Sterile water for injection50 m L,intravenous injection,3 times a day,for 2-3 d. Meanwhile,patients were orally given Rosuvastatin calcium tablet 10 mg30 min after daily dinner,8-week was a course,for 3 courses. Based on it,aspirin group received Aspirin enteric-coated tablet with initial dose of 300 mg,once a day,orally taking 100 mg from the second day,once a day,for 6 months;clopodogrel group received Clopidogrel hydrogen sulfate tablet with initial dose of 300 mg,once a day,orally taking 75 mg from the second day,once a day,for 6 months. Graft patency rate,and platelet aggregation rate,platelet aggregation compliance rate,fibrinogen（Fg）,D-dimer（D-D）,platelet count（PLT）,tissue-type plasminogen activator（t-PA）before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS：There were no significant differences in the graft patency rate and incidence of adverse reactions in 2 groups（P〈0.05）. Before treatment,there were no significant differences in platelet aggregation rate,platelet aggregation compliance rate,Fg,D-D,PLT and t-PA in 2 groups（P〈0.05）. After treatment,platelet aggregation rate,Fg and D-D level in 2 groups were significantly lower than before,platelet aggregation compliance rate,PLT and t-PA level were signifi

关 键 词：阿司匹林 氯吡格雷 冠状动脉内膜剥脱并冠状动脉搭桥术 血管狭窄 抗血小板聚集 

分 类 号：R541[医药卫生—心血管疾病]