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目的:观察溶栓治疗基础上联合氯吡格雷治疗ST段抬高型急性心肌梗死(STEAMI)的长期疗效及安全性。方法:将100例72h以内发病的未行冠状动脉介入治疗的STEAMI患者随机均分为2组。A组行标准治疗(即静脉溶栓、抗凝、降脂、减轻心脏氧耗等),B组患者在A组治疗基础上入院即刻给予氯吡格雷300mg口服,继之75mg/d,治疗1年。观察梗死后心绞痛发作及死亡、再发心肌梗死或脑卒中的联合终点。结果:与A组相比,B组患者梗死后心绞痛发作明显减少,死亡、再发心肌梗死或脑卒中的联合终点也有显著下降,2组比较差异有统计学意义,P<0.05;2组均无主要和次要出血事件发生,轻微出血发生率2组比较差异无统计学意义(P>0.05)。结论:STEAMI患者在溶栓治疗的基础上早期加用氯吡格雷300mg负荷量,继之75mg/d口服,治疗1年,可显著降低梗死后心绞痛的发作及死亡、再发心肌梗死或脑卒中的联合终点,且安全耐受性好。
Objective: To observe the long-term efficacy and safety of thrombolysis combined with clopidogrel in the treatment of ST-elevation acute myocardial infarction (STEAMI). Methods: One hundred patients with STEAMI who had undergone coronary intervention within 72h were randomly divided into two groups. A group of standard treatment (ie, intravenous thrombolysis, anticoagulant, lipid-lowering, reduce heart oxygen consumption, etc.), patients in group B were treated on the basis of group A immediately given clopidogrel 300mg orally, followed by 75mg / d, treatment 1 year. Observe the onset of angina and death after infarction, and then the combined endpoint of myocardial infarction or stroke. Results: Compared with group A, the incidence of post-infarction angina pectoris in group B was significantly decreased, and the combined endpoint of death, recurrent myocardial infarction or stroke was significantly decreased as well. There was significant difference between the two groups (P <0.05) There was no major or minor bleeding, and the incidence of mild bleeding was no significant difference between the two groups (P> 0.05). CONCLUSIONS: STEAMI patients treated with clopidogrel at a dose of 300 mg earlier than thrombolytic therapy, followed by 75 mg / d orally for 1 year, significantly reduced the incidence and death of post-infarction angina pectoris and recurred myocardial infarction or stroke The joint end point, and good safety tolerance.