双倍剂量氯吡格雷治疗老年冠状动脉介入治疗术后氯吡格雷抵抗患者的疗效与安全性  

Efficacy and safety of double-dosage Ciopidogrel in elderly patients with Clopidogrel resistance after percutaneous coronary intervention

作　　者：徐先静[1] 段明勤[1] 曹选超[1] Xu Xianjing Duan Mingqin Cao Xuanchao(General Ward, Henan Province People＇s Hospital, Zhengzhou 450003 , Henan, Chin)

机构地区：[1]河南省人民医院康馨综合病房,郑州450003

出　　处：《中华老年医学杂志》2017年第10期1065-1068,共4页Chinese Journal of Geriatrics

基　　金：基金项目：河南省科技攻关计划项目（132102310192）

摘　　要：目的评估常规剂量及双倍剂量氯吡格雷治疗老年急性冠状动脉脉综合征（ACS）经皮冠状动脉介入治疗（PCI）术后氯吡格雷抵抗患者的疗效与安全性，为老年患者应用抗血小板药物提供临床依据。方法本研究为随机对照临床试验，将老年急性冠状动脉综合征PCI术后氯吡格雷抵抗者（血小板抑制率〈30％）108例，随机分为对照组54例（氯吡格雷75mg，1次／d），试验组54例（氯吡格雷150mg，1次／d）。观察服药前、服药后7、30、90及180d血栓弹力图吡啶二磷酸腺苷（ADP）诱导的血小板抑制率及主要不良心血管事件和出血、呼吸困难等不良反应的发生率。结果与对照组比较，试验组治疗后7、30、90及180d血小板抑制率明显升高，分别为（22．4±4．5）％和（37．6±4．5）％、（22．6±4．3）％和（38．8±4．7）％、（22．7±4．6）％和（38．5±4．5）％、（23．7±4．3）％和（38．9±4．6）％（均P〈0．05）；试验组主要不良心血管事件发生率较对照组降低（3．7％和35．1％）（x2=15．133，P〈0．001）；试验组出血及呼吸困难发生率较对照组高，但差异无统计学意义（均P〉0．05）。结论老年急性冠状动脉综合征PCI术后氯吡格雷抵抗患者，双倍剂量的氯吡格雷疗效优于常规剂量，且安全性良好。Objective To evaluate the efficacy and safety of double-dosage Clopidogrel in elderly patients with Clopidogrel resistance after pereutaneous coronary intervention（PCI）. Methods The randomized control trials design was used in this study. 108 senile ACS patients with Clopidogrel resistance（platelet inhibition rate〈 30 % ） were randomized into control group （Clopidogrel 75 mg/d, n =54）and experimental group（Clopidogrel 150 mg/d, n= 54）. Blood platelet inhibition rate of ADP, major adverse cardiovascular events and main side effects were observed before and 7 d,30 d,90 d and 180 d after intervention. Results Compared with control group, the experimental group was associated with significantly increased platelet inhibition rate on 7 d （22.4 ± 4.5 ）% vs. （37.6 i 4.5）%,30 d（22.6±4.3）%0 vs. （38.8±4.7）%,90 d（22.7±4.6）% vs. （38.5±4.5）%,and 180 d （23.7±4.3） 0% vs. （38.9±4.6）% after treatment（all P〈0.05）. Furthermore, the incidence of main adverse cardiovascular events was also significantly lower in the experimental group（3.7 % vs. 35.1 %, x2 = 15. 133, P〈0. 001 ）. Meanwhile, the incidence of bleeding and dyspnea were higher in experimental group, but there was no significant difference between the two groups. Conclusions Compared with general dosage, double-dosage of Clopidogrel offers better curative effect and good safety in elderly ACS patients with Clopidogrel resistance after PCI.

关 键 词：急性冠状动脉综合征 血管成形术 血小板聚集抑制剂 血栓弹力描记术 

分 类 号：R541.4[医药卫生—心血管疾病]