吸烟对急性冠脉综合征患者冠脉支架置入术后抗栓治疗的影响

目的观察吸烟对急性冠脉综合征(ACS)患者冠状动脉支架置入术后近期抗栓疗效的影响。方法成功行支架置入术男性ACS患者98例,根据是否吸烟分为吸烟组(48例)和非吸烟组(50例),各组术前给予负荷剂量阿司匹林300 mg嚼服及氯吡格雷300 mg顿服,术后继续每日口服阿司匹林片100 mg及氯吡格雷75 mg。1周后比较两组的生化指标,临床疗效,心电图疗效以及院内心脑血管缺血性事件发生情况。结果 1周后两组患者的生化指标(肌钙蛋白、肌酸激酶、超敏C反应蛋白、同型半胱氨酸、血小板计数、血小板聚集抑制率)均差异有统计学意义(P<0.05);非吸烟组临床显效率82.4%、心电图显效率76.5%,明显高于吸烟组61.2%、53.2%(P<0.05)。其中吸烟组院内死亡1例,不稳定心绞痛2例,无脑卒中及非致死性心肌梗死情况;非吸烟组无死亡病例。结论吸烟降低ACS患者术后抗栓治疗的近期疗效,增加心脑血管事件发生率,其机制与降低抗栓药物的血小板活化作用可能有关。

Impacts of smoking on antithrombotic therapy after coronary stenting

Objective To observe recent impacts of smoking on antithrombotic therapy after coronary stenting and investigate the possible mechanism.Methods A total of 98 ACS male-patients received successful coronary stenting were divided into smoking group and non-smoking group.A loading dose of 300 mg clopidogrel and aspirin were given to the patients before surgery,followed by a maintenance dose of 75mg / day clopidogrel and 100 mg / day aspirin.We determined the biochemical markers,clinical efficacy,ECG efficacy,and cardiovascular、cerebrovascular e-vents after one week in hospital.Results Biochemical markers on both groups had statistical differences（P 0.05）,the clinically significant efficiency in non-smoking group was 82.4%,ECG significant efficiency was 76.5%,much higher than that in the smoking group（P 0.05）.1 cases died in hospital and 2 cases had unstable angina attack in smoking group,and no deaths in non-smoking group.Conclusion Smoking reduced recent impacts on antithrombotic therapy after coronary stenting,added the incidence of cardiovascular and cerebrovascular events rate,the mechanism may be related with reducing platelet activation of antithrombotic drugs.