摘要
目的:评价ST段抬高急性心肌梗死rt-PA纤溶治疗加用氯吡格雷的有效性和安全性。方法:87例ST段抬高的急性心肌梗死患者,90 min内经静脉接受50 mg rt-PA纤溶治疗,按是否加用氯吡格雷随机分两组:治疗组每天给予氯吡格雷75 mg,对照组给予安慰剂。临床观察指标为梗死血管远端TIMI级血流、冠脉内血栓、出血并发症、住院期间心血管事件。结果:氯吡格雷治疗组梗死血管远端TIMI级血流比对照组显著升高(72.1%vs50.0%,P<0.05),治疗组冠脉内血栓比对照组显著降低(34.9%vs 56.8%,P<0.05)。两组出血并发症无统计学差别(P>0.05)。两组再梗死、心源性死亡、总死亡差异无显著性(P>0.05)。结论:ST段抬高急性心肌梗死rt-PA纤溶治疗加用氯吡格雷改善梗死血管通畅率,并不增加出血并发症。
Objective：To investigate the effectiveness and safety of addition of clopidogrel to fibrinolytic therapy for myocardial infarction with ST-segment elevation（STEMI）. Methods.Eighty-seven STEMI patients admitted less than 12 hours of onset received fibrinolytic therapy（50 mg rt-PA in 90 minutes）. They were randomizedly divided into two groups according to whether or not clopidogrel（75 mg ,once daily） was added. We investigated TIMI myocardial- perfusion grade of 3,intracoronary thrombus, hemorrhagic complications, and cardiac events during hospitalization. Results： As compared with placebo, more optimal myocardial reperfusion （defined by a TIMI myocardial-perfusion grade of 3）in clopidogrel group（72. 1% vs 50. 0% ,P（0.05）. Intracoronary thrombus was significantly reduced in clopidogrel group compared with the control group（34.9% vs 56.8% ,P〈0. 05）. The incidence of hemorrhagic complications associated with thrombolytic therapy was the same for both groups（6.9% vs 6.8% ,P〉0.05）. There was no significant difference in the incidence of reinfarction,cardiac death,and total death in both groups. Conclusions：In patients who have myocardial infarction with ST-segment elevation and who receive aspirin and a standard fibrinolytic regimen,the addition of clopidogrel improves the patency rate of the infarct-related artery and does not increase hemorrhageic complications.
出处
《临床医药实践》
2007年第4期251-253,共3页
Proceeding of Clinical Medicine
