【摘要】 目的探讨阿司匹林联合氯吡格雷抗血小板治疗对接受非体外循环下冠状动脉旁路移植(OPCAB)患者术后血小板聚集力的影响和安全性。方法选取60例接受OPCAB治疗的冠心病患者,随机分成单用阿司匹林组(n=30)与联合阿司匹林和氯吡格雷组(n=30),检测术前、服药后的第1~6、8、10天血小板聚集力的变化,比较两组阿司匹林抵抗(AR)发生率,观察术后两组出血和相关并发症。结果单用阿司匹林组术后1例第2天并发肠梗阻,联合阿司匹林和氯吡格雷组术后出现1例输注血小板、1例粒细胞缺乏而退出试验。两组术前基线资料、手术特征差异均无统计学意义(P>0.05);单用阿司匹林组服药后AR发生率为62.1%,联合阿司匹林和氯吡格雷组为32.1%,两组比较差异具有统计学意义(P<0.05);两组血小板聚集力在服药后第1、2天分别为(24.2±31.9)%和(49.6±32.6)%,(13.8±27.2)%和(37.6±37.4)%,差异具有统计学意义(P<0.05)。服药后两组不良事件差异无统计学意义(P>0.05)。多元回归分析显示,服用氯吡格雷与AR独立相关,OR值为0.09(P=0.044)。结论联合使用阿司匹林和氯吡格雷治疗能减少OPCAB术后AR的发生率,OPCAB术后早期联合使用阿司匹林和氯吡格雷抗血小板治疗具有良好的安全性。更多还原

【Abstract】 Objective To investigate the effect of the anti-platelet effect of aspirin plus clopidogrel on off-pump coronary artery bypass(OPCAB) grafting and the possible side effects of such therapy.Methods Sixty patients who underwent standard OPCAB were randomized immediately after surgery in two groups:the aspirin alone group of 30 patients who received aspirin(100 mg) daily; and the combination group of 30 patients who received clopidogrel(75 mg) plus aspirin(100 mg) daily.Platelet aggregation in response to arachidonic acid(PL AA) and adenosine diphosphate(PL ADP) were measured at baseline(before surgery) and 1-6,8,and 10 days after the medication.Postoperative bleeding and other perioperative parameters were compared between these two groups.Results There were no significant differences between the two groups in perioperative findings including average number of distal anastomosis,operative time,postoperative bleeding,ventilation time,and intensive care unit stay(all P>0.05).The proportion of patients with the PL AA above 20% value was significantly lower in the combination group than those in the aspirin alone group(32.1% vs 62.1%,P<0.05).PL AA of two groups one and two days after taking aspirin or plus clopidogrel were(24.2±31.9)% vs.(49.6±32.6)%and(13.8±27.2)% vs.(37.6±37.4)%,respectively(P<0.05).No obvious postoperative complication was noted in both groups.Multivariate analysis showed that clopidogrel administration was independently correlated with aspirin resistance(P=0.044,OR=0.09; 95% CI=0.07-0.48).Conclusion Early combined use of aspirin plus clopidogrel after OPCAB can remarkably reduce OPCAB-related aspirin resistance and enjoy similar safety.更多还原