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目的探讨不同方法治疗急性冠状动脉综合征(ACS)的临床疗效。方法241例ACS患者随机分为3组:治疗1组、治疗2组及对照组,3组均常规应用抗心绞痛药物治疗(包括阿司匹林、低分子肝素、硝酸酯类、辛伐他汀及β受体阻滞剂等);治疗1组在常规治疗的同时,首次给予负荷剂量的氯吡格雷300mg,口服,继之以75mg1次/d,口服,出院后停服氯吡格雷;治疗2组在常规治疗的同时,首次给予负荷剂量的氯吡格雷,300mg,口服,行冠状动脉介入治疗,继之以氯吡格雷75mg,1次/d,口服,出院后继续服用氯吡格雷1年;均随访1年,观察3组心绞痛发作频率、程度、心电图改变、心脏超声改变、运动耐量,评价治疗效果。结果治疗1组症状和心电图有明显的改善,总有效率为80.2%(69/86),但1年后的心脏超声EF值及运动耐量有所下降;治疗2组症状和心电图有很明显的改善,总有效率90.4%(75/83),1年后的心脏超声EF值无明显差别,但运动耐量较前提高;对照组症状和心电图有明显改善,总有效率66.7%(48/72),1年内有反复发作,1年后心脏超声EF值及运动耐量均下降。结论氯吡格雷、阿司匹林和辛伐他汀联合应用于ACS疗效更佳,远期可增加运动耐量,提高生存质量。
Objective To investigate the clinical efficacy of different methods in the treatment of acute coronary syndrome (ACS). Methods 241 patients with ACS were randomly divided into 3 groups: treatment 1 group, treatment 2 and control group. All 3 groups were given routine anti-anginal drug therapy (including aspirin, low molecular weight heparin, nitrates, simvastatin and β receptor Blockers, etc.); treatment group 1 in the conventional treatment at the same time, the first dose of clopidogrel 300mg, oral, followed by 75mg1 times / d, oral, discharge clopidogrel after stopping; treatment 2 in the conventional At the same time of treatment, the first dose of clopidogrel, 300mg, was given orally. The patients were treated with clopidogrel 75mg once a day orally, and were given clopidogrel for 1 year after discharge. All patients were followed up One year, the frequency, degree, electrocardiogram changes, echocardiographic changes and exercise tolerance of angina pectoris in 3 groups were observed and evaluated. Results The symptom and electrocardiogram in treatment group 1 were significantly improved. The total effective rate was 80.2% (69/86), but the value of echocardiographic echocardiography and exercise tolerance decreased after one year. The symptoms and electrocardiogram of treatment group 2 were obvious The total effective rate was 90.4% (75/83). There was no significant difference in echocardiographic EF value after 1 year, but the exercise tolerance was improved. The symptoms and electrocardiogram of the control group were significantly improved with a total effective rate of 66.7% (48/72) ), Recurrent within 1 year, 1 year after the echocardiographic EF value and exercise tolerance decreased. Conclusions The combination of clopidogrel, aspirin and simvastatin is more effective in treating ACS. Long-term increase of exercise tolerance and quality of life.