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目的：探讨不同剂量氯吡格雷治疗急性ST 段抬高心肌梗死(STEMI)的疗效及安全性。方法：178 例急性STEMI 患者随机分为高剂量组和常规剂量组，每组各69 例。两组均给予阿司匹林、静脉溶栓、抗凝及降脂等常规治疗，高剂量组和常规剂量组分别口服氯吡格雷负荷量600 mg、300 mg，之后两组患者给予维持量75 mg/d。结果：治疗30 d 后，高剂量组总有效率为91.0%，常规剂量组为77.5%，差异有统计学意义(P<0.05)；高剂量组治疗后36 h 及30d 的MACE 发生率为3.4%和6.7%，常规剂量组为12.4% 和18.0%，差异均有统计学意义(P<0.05)；两组出血发生率分别为9.0%，5.6%，差异无统计学意义（P>0.05）。结论：高剂量（600 mg）氯吡格雷治疗急性STEMI 疗效优于常规剂量（300 mg），且具有良好的安全性。

英文摘要:

Objective: To explore the clinical effect and safety of different doses of clopidogrel on the treatment of acute ST-segment elevation myocardial infarction (STEMI). Methods：178 patients with acute STEMI were randomly divided into two groups. All the cases were given aspirin, intravenous thrombolysis, anticoagulants, lipid-lowering and so on. The patients respectively received 600 mg (high dose group, n=89) and 300 mg (normal dose group, n=89) loading dose of clopidogrel administration, followed by the maintenance dose of 75 mg/d. Result: The total effect rate of high dose group and normal dose group were 91.0% and 77.5% , the difference was statistically significant (P<0.05). The MACE rates within 24 hours(3.4% vs.12.4%)and 30 days(6.7% vs.18.0%) in high dose group were significantly lower than those in normal dose group (P<0.05). The rate of bleeding in high dose and normal dose group was 9.0% and 5.6%, respectively, with no significantly difference (P>0.05). Conclusions: High dose treatment of clopidogrel (600 mg) is better than normal dose treatment (300 mg) in acute STEMI and both methods have good safety.

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