600 mg负荷量氯吡格雷对直接经皮冠状动脉介入患者心肌灌注的影响

目的 探讨600mg负荷量氯吡格雷对直接经皮冠状动脉介入（PCI）患者心肌灌注的影响.方法 将接受直接PCI的急性ST段抬高型心肌梗死（STEMI）患者86例,根据氯吡格雷负荷量随机分为300 mg负荷量组（43例）和600 mg负荷量组（43例）,比较两组患者的基础资料,PCI术前、术后12 h、术后24 h PIGF、hs-CRP水平,sumSTR≥50％和MBG 2/3分级在两组中的比例,以及住院期间严重不良心脏事件（MACE）发生率等,评价600 mg氯吡格雷对行直接PCI的STEMI患者心肌灌注的影响.结果 ①600 mg负荷量组中sumSTR≥50％和MBG 2/3级的比例明显高于300 mg负荷量组,差异有统计学意义（P＜0.05）.②两组相比,PCI前和PCI后12 h 600 mg负荷量组PIGF和hs-CRP水平差异无统计学意义（P＞0.05）,而术后24 h PIGF和hs-CRP水平差异有统计学意义（P＜0.05）.③两组间心脏不良事件、出血等事件发生率比较差异无统计学意义（P＞0.05）.结论 STEMI行直接PCI患者给予600 mg负荷量氯吡格雷比300 mg负荷量更能改善心肌组织的灌注.

The influence of 600 nag loading clopidogrel on myocardial perfusion in patients undergoing primary percutaneous coronary intervention

Objective To investigate 600 mg loading clopidogrel is superior to the 300 mg loading in improving myocardial perfusion in patients with STEMI undergoing primary PCI.Methods 86 patients with ST elevation myocardial infarction （STEMI） were divided into two groups according to clopidogrel loading doses（300 mg loading or 600 mg loading）.The basic characteristics,the level of hs-CRP and PIGF,sumSTR％,MBG classification and the incidence of MACE were compared and analyzed.Finally the relationship between the 600 mg loading clopidogrel and myocardial perfusion in STEMI undergoing primary PCI were observed.Results （1）The proportion of sumSTR ≥ 50％ and MBG2/3 in 600 mg loading group was significantly higher than the 300 mg loading group,which has statistical significance（P＜0.05）.（2）PIGF and hs-CRP level have no difference in two groups before PCI and after PCI 12 h（P＞0.05）.But there was different after PCI 24 h（P＜0.05）.（3）The incidence rate of MACE,bleeding complications was not different between two groups （P＞0.05）.Conclusion The 600 mg loading clopidogrel could improve myocardial reperfusion more than the 300 mg loading.