论文部分内容阅读
目的探讨不同剂量氯吡格雷对老年患者经皮冠状动脉介入治疗(PCI)术后心血管缺血及出血事件发生率的影响。方法选取商丘市第一人民医院2014年8月—2015年8月择期实施PCI术的122例老年冠心病患者,随机分为两组,各61例。小剂量组:75 mg/d氯吡格雷与100 mg/d阿司匹林;大剂量组:100 mg/d氯吡格雷与100 mg/d阿司匹林。统计两组PCI术后12个月心血管缺血及出血事件发生率,并对两组血栓弹力图检测数据(反应时间、凝血时间、凝固角、最大幅度)、药物(阿司匹林抑制与氯吡格雷抑制)效果进行观察比较。结果大剂量组PCI术后12个月心血管缺血发生率31.15%,低于小剂量组的62.30%;大剂量组再出血事件发生率24.59%,高于小剂量组的4.92%,差异均有统计学意义(P<0.05);两组凝固角差异无统计学意义(P>0.05);与小剂量组相比,大剂量组最大幅度较低,凝血及反应时间较高,差异有统计学意义(P<0.05);两组阿司匹林抑制率差异无统计学意义(P>0.05);与小剂量组相比,大剂量组氯吡格雷抑制率较高,差异有统计学意义(P<0.05)。结论老年患者PCI术后维持100 mg/d氯吡格雷治疗,虽可有效减少心血管缺血事件发生,但会一定程度增加出血风险,临床治疗中应予以重视。
Objective To investigate the effects of different doses of clopidogrel on the incidence of cardiovascular ischemic and hemorrhagic events after percutaneous coronary intervention (PCI) in elderly patients. Methods A total of 122 elderly patients with coronary heart disease who underwent PCI during August 2014 to August 2015 in Shangqiu First People’s Hospital were randomly divided into two groups of 61 patients. Low-dose group: 75 mg / d clopidogrel and 100 mg / d aspirin; high-dose group: 100 mg / d clopidogrel and 100 mg / d aspirin. The incidence of cardiovascular and bleeding events at 12 months after PCI was calculated. The data of thromboelastometry (reaction time, clotting time, coagulation angle, maximal amplitude), drug (aspirin inhibition and clopidogrel Inhibition) effects were observed and compared. Results The incidence of cardiovascular ischemia at 12 months after PCI in high-dose group was 31.15%, lower than that in low-dose group (62.30%). The incidence of rebleeding in high-dose group was 24.59%, higher than that in low-dose group (P <0.05). There was no significant difference in the coagulation angle between the two groups (P> 0.05). Compared with the low-dose group, the maximum dose group had the most significant lower coagulation and reaction time, the difference was statistically significant (P <0.05). There was no significant difference in aspirin inhibition rate between the two groups (P> 0.05). Compared with the low dose group, the inhibition rate of clopidogrel in the high dose group was higher (P < 0.05). Conclusion Clopidogrel 100 mg / d after PCI in elderly patients can effectively reduce the incidence of cardiovascular ischemic events, but it may increase the risk of bleeding to a certain extent and should be paid more attention in clinical treatment.