摘要
目的 :探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者接受标准抗血小板治疗72 h后,使用血栓弹力图(thromboelastogram,TEG)测定血小板聚集抑制率的变化,并探讨其临床意义。方法:选取60例首次发病的ACS患者,在确诊后给予负荷剂量阿司匹林300 mg及氯吡格雷300 mg,第2天起常规口服阿司匹林100 mg/d及氯吡格雷75 mg/d,治疗72 h后采血并记录当时胸痛症状,通过TEG测定患者的血小板聚集抑制率。结果:根据72 h后是否存在胸痛将患者分为2组,2组患者在年龄、性别、高血压、糖尿病、高脂血症、应用药物、血小板计数方面差异均无统计学意义(P>0.05);胸痛未缓解组的阿司匹林血小板聚集抑制率为(74.38±9.13)%,明显低于胸痛缓解组[(82.08±8.68)%](P=0.002)。另外,当最大血块强度大于68 mm时,氯吡格雷的血小板聚集抑制率明显下降(P<0.05)。结论:TEG测定能客观反映ACS患者药物治疗后的血小板聚集抑制率变化,对抗血小板药物治疗有一定的指导意义。
Objective To study the inhibition of platelet aggregation in patients with the acute coronary syndrome （ACS） after 72 hours of antiplatelet therapy measured by thromboelastogram （TEG） and to analyze its clinical significance. Methods Sixty patients with first-episode ACS were enrolled. Loading doses of 300 mg aspirin and 300 mg clopidogrel were given orally at the first day and the following days were given the conventional dose （100 mg/d of aspirin and 75 mg/d of clopidogrel ）. After 72 hours, chest pain was recorded, and inhibition rate of platelet aggregation was measured by TEG method. Results The patients were divided into two groups according to the presence or absence of chest pain after 72 hours. There were no statistical differences between the two groups in age, gender, hypertension, diabetes, hyperlipidemia, drugs used and platelet count （P〉0.05）. The platelet inhibition rate by aspirin in the group with no ameliorating of chest pain [（74.38＋9.13）%] was significantly lower than that in the group with ameliorating of chest pain [（82.08±8.68）% （P= 0.002）]. In addition, when the maximum clot strength （MA） was greater than 68 ram, the platelet inhibition rate by clopidogrel decreased significantly （P〈0.05）. Conclusions The measurements of TEG can objectively reflect the change of platelet inhibition of ACS patients after drug treatment, which has certain guiding significance for antiplatelet therapy.
出处
《诊断学理论与实践》
2016年第2期142-147,共6页
Journal of Diagnostics Concepts & Practice
