急性冠脉综合征非血运重建患者联合抗血小板治疗的近期疗效观察

目的观察急性冠脉综合征(ACS)非血运重建患者阿司匹林联合氯吡格雷抗血小板治疗的近期疗效及安全性,从而为ACS非血运重建患者长期联合抗血小板治疗提供循证医学证据。方法ACS非血运重建患者84例,随机单盲分为两组:阿司匹林治疗组(A组,n=44)及阿司匹林加氯吡格雷联合抗血小板治疗组(B组,n=40)。两组均给予阿司匹林、低分子肝素、硝酸甘油、β受体阻滞剂、他汀类药物等常规治疗。联合抗血小板组给予氯吡格雷负荷量300 mg后,75 mg/d维持。两组患者随访1～4年,观察主要心脑血管事件(MACCE)及药物不良反应发生率。结果联合抗血小板组非致死性MI、复发性心绞痛及因症状性心肌缺血再住院率低于阿司匹林组(P<0.05);死亡率和缺血性卒中发生率亦低于阿司匹林组,但差异无显著性(P>0.05);皮肤黏膜出血等不良反应发生率与阿司匹林组比较差异无显著性(P>0.05)。结论ACS非血运重建患者给予较长期联合抗血小板治疗较单纯阿司匹林治疗可进一步受益且服药安全性并未降低。

Short term effect of combined anti-blood platelet treatment for patient with acute coronary syndrome and non-blood circulation reconstruction

Objective To observe the safety and effectiveness of the aspirin combined clopidogrel inhibiting platelet treatment and to provide evidence for the of long term combined anti-blood platelet treatment for patient with acute coronary syndrome(ACS)and non-blood circulation reconstruction.Methods Patients with acute coronary syndrome and non-blood circulation reconstruction were randomly divided into aspirin group(n=44) and combined anti-blood platelet treatment group(n=40).Two groups were given routine treatment of aspirin,low molecular weight heparin,Nitroglycerin,β-blocker and statins.The patients of aspirin combine clopidogrel group received 300mg loading-dose of clopidogrel orally at admitted time,followed by 75mg perday.The follow-up period was in the range of 1 year to 4 years.The MACCE and adverse drug reaction were observed.Results Comparing with aspirin group,the incidence of MACCE and rehospitalization was lower in combined anti-blood platelet treatment group(P<0.05).There was no significant difference in the incidence of adverse drug reaction between the two groups(P>0.05).Conclusion The treatment of long term combined anti-blood platelet is better than aspirin alone.It is safe and beneficial for patients with non-blood circulation reconstruction and ACS.