抗血小板药物对冠心病支架植入术后再狭窄防治效果的观察

目的 :观察冠状动脉介入治疗术术前应用不同抗血小板药物对血中血小板活性、功能、凝血功能和术后半年再狭窄发生的影响。方法 :行经皮腔内冠状动脉成型术及支架植入术 （PCI）治疗的冠心病患者 82 6例 ,按术前服用抗血小板药物种类和服用时间分为 3组 ,第 1组 （n =383）为术前 3d服用阿斯匹林 0 .3g +抵克力得 2 5 0mg。第 2组 （n =35 6 ）为术前 3d服用阿斯匹林 0 .3g +氯比格雷 75mg。第 3组 （n =87）为急诊PCI术前 2h ,服用阿斯匹林0 .3g +氯比格雷 30 0mg ,从上述 3组中各随机抽取 30例患者 ,于PCI术前采血。采用TXYM 91型血小板聚集仪测定血小板最大聚集率 （MPAR） ,双抗夹心法 （ELISA）测定血小板α颗粒膜蛋白 （GMP 14 0 ）及血栓烷B2 （TXB2 ）的浓度。随访 82 6例患者再狭窄发生的情况。结果 :服用阿斯匹林 +氯比格雷血中血小板活性、功能及凝血功能优于服用阿斯匹林 +抵克力得。术后半年第 3组与第 2组PCI术后再狭窄发生率显著低于第一组 （P <0 .0 1）。结论 :术前服用阿斯匹林 +氯比格雷的疗效较好 ,预防再狭窄安全有效。

Effect of antiplatelet drugs on the incidence of restenosis after percutaneous transluminal coronary angioplasty and in-stent implantation

AIM: To assess the effects of different antiplatelet drugs given before the percutaneous transluminal coronary angioplasty and in-stent implantation (PCI) on platelet 's character and cruor function to restenosis a half year after the operation. METHODS: 826 patients with coronary heart disease who had undergone PCI were divided into 3 groups according to the administration of different antiplatelet drugs and at different times before PCI.The first group(n=383) patients took Ticlopidine 250 mg/d,Aspirin 0.3 g/d continulously and were phlebotomized 3 days later. The second groups(n=356) patients took Clopidogrel 75 mg/d, Aspirin 0.3 g/d continulously and were phlebotomized 3 days later. The third group(n=87) patients took Clopidogrel 300 mg bolus, Aspirin 0.3 g and were phlebotomized 2 hours later. From each group 30 patients were chosen at random. They were all phlebotomized before PCI. MPARs (Maximal Platelet Aggregation Rate) were determined by using enhanced turbidity. The plasma levels of GMP-140 and TXB2 were measured by ELISA. 826 patients were followed up for restenosis. RESULTS: Platelet 's c haracter and cruor function of the patients given Clopidogrel were better than those of the patients given ticlopidine. A half year after the operation,the incidences of restenosis in the third and the second group were lower than in the first one. CONCLUSION:Effect of Clopi dogrel and Aspirin 3 dags before PCI is better than that of any other antiplatelet drug. It is safe and feasible in the prevention of in-stent restenosis.