| 谢立强 黄河 陈炜 彭辉兵 王启林.高负荷剂量氯吡格雷联合替罗非班在非ST段抬高型急性冠状动脉综合
征患者经皮冠状动脉介入中的应用[J].现代生物医学进展英文版,2014,14(27):5307-5310. |
| 高负荷剂量氯吡格雷联合替罗非班在非ST段抬高型急性冠状动脉综合
征患者经皮冠状动脉介入中的应用 |
| The Application of High Loading Dose of Clopidogrel Combined withTirofiban in the Percutaneous Coronary Intervention (PCI) Treatment ofPatients with High-risk Non-ST-elevation Acute Coronary Syndromes |
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| DOI： |
| 中文关键词: 冠状动脉疾病 药物疗法 |
| 英文关键词: Coronary artery disease Drug therapy |
| 基金项目:云南省教育厅科学研究基金项目（2012Z076） |
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| 中文摘要: |
| 目的：探讨高负荷剂量氯吡格雷联合替罗非班在高危非ST 段抬高型急性冠状动脉综合征（acute coronary syndrome，ACS）
患者经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）中的作用及安全性。方法：入选208 例高危非ST 段抬高型
ACS患者，根据PCI术前氯吡格雷负荷量不同，随机分为观察组和对照组。对照组：112 例，以氯吡格雷300 mg+ 替罗非班(用法同
观察组)治疗，观察组：96例，以氯吡格雷600 mg +替罗非班0.4 滋g/(kg·min)在30 min 内静脉注射。继以0.1 g/(kg·min)由微量泵
静脉持续泵入至手术后36 h，分别测定两组最大血小板聚集率(MPAR)变化、PCI 术后TIMI心肌灌注分级(TMPG)；随访住院期间
和30 d内不良心血管事件和出血事件。结果：两组临床情况、PCI前负荷剂量氯吡格雷给药时间、支架置入数目比较差异无统计
学意义(P>0.05)；用药后2 h、6 h、术后24 h两组MPAR均较用药前明显降低(P<0.05)；用药后6 h两组MPAR 均低于用药后2 h
(P<0.05)；用药后2 h时观察组MPAR 低于对照组(P<0.05)。PCI术后TMPG 3级获得率观察组高于对照组(P<0.05)；30 d内复合心
血管事件发生率、出血并发症两组比较差异均无统计学意义(P>0.05)。结论：PCI术前负荷氯吡格雷600 mg可以更有效、更迅速地
抑制患者的MPAR，联合应用替罗非班时仍可改善心肌灌注，且安全可行。 |
| 英文摘要: |
| Objective:To study the effect and safety of the usage of tirofiban on the basis of the high loading dose of clopidogrel
in the percutaneous coronary intervention (PCI) treatment of patients with high-risk non-ST-elevation acute coronary syndromes.Methods:208 cases of high-risk non-ST-elevation ACS patients were chosen and divided randomly into study group and control group
according to the different amount of loading dose of clopidogrel. Control group consist of 112 cases of patients who were treated with
300 mg and tirofiban (same dose as the observation group). Study group consist of 6 cases who were given an intravenous injection of
600 mg clopidogrel and 0.4 ug/ (kg·min) tirofiban in 30 min, followed by another administration of 0.1 g/ (kg·min) via micro-pump 36
hours after operation. The maximum changes of MPAR, TIMI and the myocardial perfusion grading(TMPG) post PCI for the two groups
were observed and recorded respectively. The adverse cardiovascular events and bleeding events during the hospital stay and during thirty
days follow-up period were analysed.Results:There were no significant difference in clinical cases, the preloading time of clopidogrel
before PCI and the number of Stent implantation between the two group (P>0.05); For 2 hours, 6 hours after treatment and for 24 hours
after operation, MPAR all significantly decreased in the two groups (P<0.05) compared with that before treatment. MPAR of both groups
for 6 h after treatment presented lower than that of the two groups 2 hours after treatment (P<0.05); MPAR of the study group was
significantly lower than that of the control group 2 hours after treatment (P<0.05). The rate of TMPG level 3 post PCI of the study group
was higher than that of the control group after operation(P<0.05). There were no significant differences in the incidence rate of combined
cardiovascular events within 30d between the two groups and the bleeding complication were also not significantly different(P>0.05).Conclusion:The loading of 600 mg clopidogrel can inhibit MPAR of the patient before operation more effectively and rapidly, joint
application of tirofiban can improve myocardial perfusion and is safe and feasible. |
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