阿司匹林和氯吡格雷分别用于冠状动脉内膜剥脱并冠状动脉搭桥术后血管再狭窄的预防效果和安全性比较

发布时间：2018-04-10 14:00

本文选题：阿司匹林 + 氯吡格雷　；参考：《中国药房》2017年06期

【摘要】：目的:比较阿司匹林和氯吡格雷分别用于冠状动脉内膜剥脱并冠状动脉搭桥术后血管再狭窄的预防效果和安全性。方法:110例冠状动脉粥样硬化性心脏疾病患者随机分为阿司匹林组(55例)和氯吡格雷组(55例)。两组患者冠状动脉内膜剥脱并冠状动脉搭桥术后均静脉微泵硝酸甘油注射液10 mg+5%葡萄糖注射液共20 m L维持48~72 h,必要时静脉泵入盐酸多巴胺注射液1~5μg/kg。术后拔除气管插管,给予注射用头孢呋辛钠1.5 g加入灭菌注射用水50 m L,静脉滴注,每日3次,连用2~3 d。同时,每日晚饭后30 min口服瑞舒伐他汀钙片10 mg,8周为1个疗程,连用3个疗程。在此基础上,阿司匹林组患者给予阿司匹林肠溶片首次负荷剂量300 mg,口服,每日1次,第2日起口服100 mg,每日1次,连用6个月;氯吡格雷组给予硫酸氢氯吡格雷片首次负荷剂量300 mg,每日1次,第2日起口服75 mg,每日1次,连用6个月。观察两组患者的桥血管通畅率,治疗前后血小板聚集率、血小板聚集达标率、纤维蛋白原(Fg)、D-二聚体(D-D)、血小板计数(PLT)、组织型纤溶酶原激活物(t-PA)水平及不良反应发生情况。结果:两组患者桥血管通畅率、不良反应发生率比较,差异均无统计学意义(P0.05)。治疗前,两组患者血小板聚集率、血小板聚集达标率、Fg、D-D、PLT、t-PA水平比较,差异均无统计学意义(P0.05)。治疗后,两组患者血小板聚集率、Fg、D-D水平均显著低于同组治疗前,血小板聚集达标率、PLT、t-PA水平均显著高于同组治疗前,差异均有统计学意义(P0.05),但两组间比较差异均无统计学意义(P0.05)。结论:在常规治疗的基础上,阿司匹林、氯吡格雷用于冠状动脉内膜剥脱并冠状动脉搭桥术后,均可抑制血小板聚集,减少血栓形成,维持桥血管通畅,预防血管再狭窄,且安全性均较好。
[Abstract]:Aim: to compare the efficacy and safety of aspirin and clopidogrel in preventing restenosis after coronary endarterectomy and coronary artery bypass grafting.Methods 110 patients with coronary atherosclerotic heart disease were randomly divided into aspirin group (n = 55) and clopidogrel group (n = 55).After coronary endarterectomy and coronary artery bypass grafting, the patients in both groups were treated with intravenous micropump nitroglycerin 10 mg 5% glucose injection for 4872h, and dopamine hydrochloride injection 1 5 渭 g / kg.After tracheal intubation, 1.5 g cefuroxime sodium for injection was added to 50 mL sterilizing water, intravenous drip 3 times a day for 2 days.At the same time, 30 min after supper, 10 mg calcium tablets were taken orally for 8 weeks as a course of treatment for 3 consecutive courses.On this basis, the patients in the aspirin group were given the first dose of 300 mg aspirin enteric coated tablets once a day, 100 mg daily from the 2nd day, once a day for 6 months;In clopidogrel group, the first loading dose of clopidogrel sulfate was 300 mg, once a day, and 75 mg orally from the 2nd day, once a day for 6 months.Results: there was no significant difference between the two groups in the patency rate of grafts and the incidence of adverse reactions (P 0.05).Before treatment, there was no significant difference in platelet aggregation rate and platelet aggregation rate between the two groups (P 0.05).Conclusion: on the basis of routine treatment, aspirin and clopidogrel can inhibit platelet aggregation, reduce thrombosis, maintain graft patency and prevent restenosis after coronary endarterectomy and coronary artery bypass grafting.And the safety is good.
【作者单位】：济宁市第一人民医院心外科一病区;
【分类号】：R654.2

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