摘要
目的 分析负荷剂量的氯吡格雷在老年急性心肌梗死患者直接支架术中运用的效果和安全性。方法 老年急性心肌梗死患者接受经皮冠状动脉支架成形术患者142例，术前给予氯吡格雷负荷量300mg顿服，术后75mg／d×3—6个月。同时联合应用阿司匹林、肝素等其它抗凝和抗血小板药物。测定服药后2小时患者血浆GMP-140的含量及血小板最大集聚率的变化，观察发病4周内出血、白细胞及血小板减少等并发症的发生情况，随访支架置入术后6个月内临床心血管事件的发生情况。结果所有患者均在术后3—4小时拔除鞘管，无穿刺部位显著血肿形成者，元冠状动脉急性和亚急性血栓形成者。血浆GMP-140的含量及血小板最大集聚率较用药前显著降低；术后随访6个月临床心血管事件总发生率为13．38％（19例）。全部患者术后血小板、白细胞元显著改变。未发现皮疹等不良反应。结论 负荷剂量的氯吡格雷对直接支架术的老年急性心肌梗死患者有良好的治疗效果，不良反应少，安全有效，可以快速抑制血小板的活化。
Objective To observe the effects and safety of platelet ADP receptor antagonist clopidogrel（plevix） in primary pereutaneous coronary intervention for acute myocardial infarction in the elderly patients. Methods 142 elderly patients with acute myocardial infarction who underwent primary percutaneous coronary intervention（PCI） were included. Before the operation, clopidogrel 300mg loding dose was given and then 75mg once daily After the operation 3 - 6months. Aspirin and heparin were used at the same time. Hemorrhage,white blood cell and thrombocytopenia were observed for 4 weeks. Venous blood was sampled for the determination of concentration of plasma GMP-140 and max platelet aggregation rate （MPAR） at 2 hours after drug taken. PT, KPTT, blood routine and side effects were routinely monitored. The frequency of clinical cardiovascular events were followed up to 6 months. Results All sheaths were drawn out 4 hours after the operation. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery or thrombocytopenia. At post-treatment plasma GMP-140 were lower than pre-treatment（P 〈0. 01 ）. The incidence of clinical cardiovascular events were 19 cases（ 13.38% ） at 6 month. Conclusion clopidogrel takes effect quickly. Application of clopidogrel in primary percutaneous coronary intervention for acute myocardial infarction in elderly patients is safe and effective.
出处
《临床内科杂志》
CAS
2006年第11期756-758,共3页
Journal of Clinical Internal Medicine
关键词
心肌梗死
氯吡格雷
支架
冠状动脉成形术
老年人
Myocardial Infarction
Clopidogrel
Stents
Primary Percutaneous Coronary Intervention
Aged
