氯吡格雷治疗急性心肌梗死的临床观察(1)
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[摘要] 目的：探讨氯吡格雷治疗急性心肌梗死(AMI)的有效性和安全性。方法：选择符合溶栓治疗适应证、无溶栓治疗禁忌证发病12 h以内的急性心肌梗死患者107例，将其分为观察组和对照组。对照组44例，给予肠溶阿司匹林片口服，尿激酶静脉溶栓治疗，溶栓12 h后皮下注射低分子肝素钙；观察组63例，在对照组治疗基础上加用氯吡格雷负荷量300 mg，以后75 mg/d。对两组间血管再通率、冠状动脉内血栓形成率和治疗后心肌梗死再发率、出血率、病死率及梗死后心绞痛发生率等进行比较分析。结果：患者经治疗后心绞痛发生率、再发心肌梗死率、血管再通率、冠脉内血栓形成率观察组显著低于对照组，差异有统计学意义(P<0.05)，心力衰竭率、出血率、脑梗死发生率、死亡率观察组与对照组相比差异无统计学意义(P>0.05)。结论：氯吡格雷治疗急性心肌梗死是安全有效的。
[关键词] 氯吡格雷；心肌梗死；临床观察
[中图分类号] R541[文献标识码]B[文章编号]1673-7210(2011)07(c)-146-02
Clinical observation on treatment of acute myocardial infarction by Clopidogrel
HUANG Zhutong, PAN Xuesong, HAN Fuhai
The First People's Hospital of Fangchenggang City in Guangxi Zhuang Autonomous Region, Fangchenggang 538001,China
[Abstract] Objective: To evaluate the effectiveness and safety of the treatment of acute myocardial infarction (AMI) with clopidogrel. Methods: 107 patients (68 males and 39 females, with AMI within 12 hours) without contraindication for thrombolytic therapy were divided into two groups: observation group (n=44) and control group (n=63). The patients of two groups all accepted enteric oral Aspirin, intravenous thrombolytic therap. with Urokinase and subcutaneous injection with low-molecular-weight heparin calcium after thrombolytic therapy 12 h later, and the observation group added 300 mg Clopidogrel and 75 mg once daily after the first day. The rate of patency of infarct-related anery (IRA), intracoronary thrombus, re-infarction after therapy, hemorrhagic complications, mortality and post-infarction angina were compared and analyzed between the two groups. Results: The rate of angina, re-infarction, patency of infarct-related anery (IRA) and intracoronary thrombus in observation group were obviously lower than those in control group (P<0.05). There was no significant difference in the rate of heart failure, hemorrhagic complications, cerebral infarction, and mortality in both groups (P>0.05). Conclusion: The treatment of acute myocardial infarction with clopidogrel is safe and effective.
[Key words] Clopidogrel; Myocardial infarction; Clinical observation
急性心肌梗死(AMI)发病急骤、凶险，发病24 h内病死率较高，已成为发达国家和发展中国家人口死亡的最常见原因之一，并成为严重的公共卫生问题。其发生的主要的病理生理机制是动脉粥样硬化斑块破裂，凝血系统被激活而形成血栓。及早行溶栓治疗，恢复梗死区缺血心肌再灌注，能有效地保护心功能和降低病死率，已成为AMI治疗首要的急救措施，此外缺血心肌仍受到微血管损害和再灌注损伤的综合影响。因此抗血小板、抗凝治疗及抗心肌缺血作为辅助治疗非常重要 ......
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