重组组织型纤溶酶原激活剂联合氯吡格雷治疗老年急性冠脉综合征的临床疗效观察

目的 探讨重组组织型纤溶酶原激活剂（r-TPA）联合氯吡格雷治疗老年急性冠状动脉综合征（ACS）的临床疗效。方法 选取2012年1月-2013年12月北京市朝阳区王四营社区卫生服务中心老年ACS患者92例，随机分为治疗组和对照组，每组各46例。两组患者均在入院后立刻口服300 mg硫酸氯吡格雷片，随后以75 mg/d的剂量维持服用。对照组同时给予注射用尿激酶1.5×10⁶ U加入100 mL生理盐水中静脉滴注30 min，2次/d。治疗组给予r-TPA注射粉剂，15 mg加生理盐水静脉推注，其后30 min内静脉滴注50 mg加生理盐水，剩余35 mg加生理盐水在60 min内静脉滴注。两组均连续治疗5 d。观察两组的临床疗效，比较两组患者治疗前后舒张期室间隔厚度（IVST）、左心室射血分数（LVEF）、左室舒张末内径（LVDD）、P-选择素、血管性假血友病因子（vWF）的变化。结果 治疗组和对照组的总有效率分别为93.48%、78.26%，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者IVST、LVDD、P-选择素、vWF指标均较治疗前显著降低，同组治疗前后差异有统计学意义（P<0.05），治疗后治疗组的这些观察指标均较对照组降低更加明显，两组比较差异有统计学意义（P<0.05）。治疗后，两组患者LVEF均较治疗前显著升高，同组治疗前后差异有统计学意义（P<0.05），且治疗组高于对照组，两组比较差异有统计学意义（P<0.05）。结论 r-TPA联合氯吡格雷对老年ACS患者具有较好的临床疗效，安全有效，值得临床推广应用。

Clinical observation of recombinant tissue-type plasminogen activator combined with clopidogrel in treatment of elderly acute coronary syndrome

Objective To observe the clinical efficacy of recombinant tissue-type plasminogen activator (r-TPA) combined with clopidogrel in the treatment of elderly acute coronary syndrome (ACS). Methods Elderly ACS patients (92 cases) of Wangsiying Community Health Service Center of Chaoyang District in Beijing from January 2012 to December 2013 were randomly divided into treatment and control groups, and each group had 46 cases. The patients in the two groups were po administered with Clopidogrel Sulfate Tablets immediately after admission, then kept taking with the dosage of 75 mg/d. Patients in the control group were given Urokinase for injection 1.5×10⁶ U by adding in normal saline (100 mL) slowly dripping for 30 min, twice daily. Patients in the treatment group were given r-TPA Injection Powder, 15 mg by adding in normal saline for intravenous injection, and 50 mg by adding in normal saline within 30 min for intravenous drip, then the remaining 35 mg by adding in normal saline for intravenous drip within 60 min. The patients in the two groups were treated continuously for 5 d. The total clinical efficacy was observed, including the changes of diastolic ventricular septal thickness (IVST), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDD),P-select element, and false von willebrand factor (vWF). Results The total effective rates for the patients in the treatment and control groups were 93.48% and 78.26%, respectively, with the significant difference between the two groups (P < 0.05). After the treatment, IVST, LVDD, P-select element, and vWF were more significantly reduced than those before the treatment in the two groups, and the differences were statistically significant in the same group before and after the treatment (P < 0.05). These observational indexes in the treatment group were relatively lower than those in the control group, with the significant difference between the two groups (P < 0.05). After the treatment, LVEF in the two groups was significantly elevated, and the differences were statistically significant in the same group before and after the treatment (P < 0.05 ), while was higher in the treatment group than in the control group, with the significant difference between the two groups (P < 0.05). Conclusion r-TPA combined with clopidogrel has a good clinical efficacy in the treatment of elderly ACS, and it is safe and effective, which is worthy of clinical application.