【摘要】 目的观察在标准治疗的基础上早期应用氯吡格雷对急性心肌梗死溶栓治疗的影响。方法176例ST段抬高型急性心肌梗死病人随机分为标准组和联合组。两组均接受重组组织型纤溶酶原激活物(rt-PA)溶栓治疗。溶栓前两组均给予阿司匹林300 mg口服,联合组加服氯吡格雷300 mg。溶栓结束后两组均给予阿司匹林300 mg,每天1次,3 d后改为阿司匹林100 mg,每天1次;联合组同时给予氯吡格雷75 mg,每天1次。观察冠状动脉再通率及30 d内再梗死率、梗死后心绞痛发生率及出血、急诊血运重建和心血管死亡事件。结果联合组冠状动脉再通率高于标准组,再梗死率、梗死后心绞痛发生率、急诊血运重建事件低于标准组,差别有显著性(2χ=3.98~4.44,P<0.05);总出血事件、心血管病死亡率两组无显著差别(P>0.05)。结论溶栓时早期应用氯吡格雷可增加冠状动脉再通率,减少再梗死和梗死后心绞痛的发生,使急诊血运重建事件减少。更多还原

【Abstract】 Objective To observe the efficacy of clopidogrel on thrombolytic therapy in patients with acute myocardial infarction.MethodsThis study consisted of 176 patients with acute ST-segment elevation myocardial infarction who were randomly divided into standard group and combination group.The patients in both groups received recombinated tissue plasminogen activator(rt-PA) for thrombolysis.Before starting the thrombolysis,aspirin 300 mg daily,was given to all the patients,but clopidogrel,300 mg daily,was added to patients in the combination group only.After completion of the thrombolysis,aspirin,300 mg daily,for three days,and then 100 mg daily for patients in both groups.Clopidogrel,750 mg daily,was added to patients in the combination group.The recanalization of the coronary artery,reinfarction within 30 days,post-infarction angina pectoris,hemorrhage,urgent revascularization and cardiovascular death events were observed.ResultsThe recanalization rate of the coronary artery was higher,while re-infarction rate,postinfarction angina pectoris rate,and emergency revascularization were lower in the combination group than the standard group(χ~2=3.98-4.44,P<0.05).The total hemorrhage and cardiovascular death events were of no significant difference between them(P>0.05).ConclusionAn early application of clopidogrel in thrombolytic therapy may increase a recanalization rate of the coronary artery,and decrease the incidence of re-infarction,postinfarction angina pectoris,and(emergency) revascularization.更多还原