血栓弹力图指导抗血小板治疗在冠状动脉支架植入术后患者中的应用  

Thromboelastography to Guide the Application of Antiplatelet Therapy in Patients after Coronary Artery Stent Implantation

作　　者：姜丽静[1] 倪金迪[1] 李何昊 盛凯辉 张璐[1] 江帆[1] 夏祝叶 刘洪洁 李响[1] 沈国锋[1] JIANG Li-jing;NI Jin-di;LI He-hao;SHENG Kai-hui;ZHANG Lu;JIANG Fan;XIA Zhu-ye;LIU Hong-jie;LI Xiang;SHEN Guo-feng(Department of Critical Care Medicine,Minhang Hospital,Fudan University,Shanghai 201199,China;Fudan University,Shanghai 20032,China;Shanghai Minhang District Medical Emergency Center,Department of Emergency Training,Minhang District,Shanghai 201199,China)

机构地区：[1]复旦大学附属闵行医院(上海市闵行区中心医院)重症医学科,上海201199 [2]复旦大学上海医学院,上海200032 [3]上海市闵行区医疗急救中心,应急培训科,上海201199

出　　处：《血栓与止血学》2022年第3期541-542,545,共3页Chinese Journal of Thrombosis and Hemostasis

基　　金：复旦大学附属闵行医院院级科研课题项目(编号:MHJC09);闵行区卫生和计划生育委员会科研课题项目(编号:2019MW11)。

摘　　要：目的探讨血栓弹力图(TEG)指导抗血小板治疗在冠状动脉支架植入术(PCI)术后的应用价值。方法回顾性分析2018年8月-2020年8月我院收治的PCI患者80例临床资料,依据TEG检测结果进行分组,将血小板抑制率>20%的患者设为对照组(40例),血小板抑制率<20%的患者设为观察组(40例)。对照组术后予以阿司匹林治疗,观察组予以阿司匹林联合氯吡格雷治疗,持续用药6个月。比较两组TEG指标、心脏不良事件(MACE)发生率、不良反应。结果观察组治疗后反应时间(R)、凝固时间(K)长于对照组,凝固角(α角)、最大振幅(MA)低于对照组,差异有统计学意义(P<0.05);观察组MACE发生率低于对照组,差异有统计学意义(P<0.05);两组不良反应相比,差异无统计学意义(P>0.05)。结论TEG在PCI术后应用价值高,可指导临床选用适宜药物,增强抗血小板效果,减少MACE发生。Objective To investigate the value of antiplatelet therapy guided by thromboelastography(TEG)after percutaneous coronary intervention(PCI).Methods The clinical data of 80 patients with PCI admitted to our hospital from August 2018 to August 2020 were retrospectively analyzed.According to the TEG test results,the patients with platelet inhibition rate>20%were set as the control group(40 cases),and the patients with platelet inhibition rate<20%were set as the observation group(40 cases).The control group was treated with aspirin after surgery,and the observation group was treated with aspirin combined with clopidogrel for 6 months.The incidence of adverse cardiac events(MACE)with TEG markers was compared between the two groups.Results After treatment,the reaction time(R)and coagulation time(K)in the observation group were longer than those in the control group,and the maximum amplitude(Ma)of coagulation Angle(αAngle)in the observation group was lower than that in the control group,with statistical significance(P<0.05).The incidence of MACE in observation group was lower than that in control group,and the difference was statistically significant(P<0.05).There was no significant difference in ADR between the two groups(P>0.05).Conclusion TEG has high application value after PCI,which can guide the clinical selection of appropriate drugs,enhance the antiplatelet effect and reduce the occurrence of MACE.

关 键 词：冠状动脉支架植入术 血栓弹力图 抗血小板治疗 

分 类 号：R445[医药卫生—影像医学与核医学]