负荷剂量氯吡格雷治疗急性ST段抬高心肌梗死

目的:观察标准治疗基础上联合负荷剂量氯吡格雷治疗急性ST段抬高型心肌梗死(STEMI)的疗效及安全性。方法:106例12小时以内发病的ST段抬高型心肌梗死患者随机分为2组,2组均在入院后前3天给予阿司匹林300 mg.d~(-1),此后给予阿司匹林100 mg.d~(-1),A组不给予氯吡格雷治疗,B组入院即刻给予氯吡格雷300 mg,继之75 mg.d~(-1)治疗,平均随访30天。观察溶栓血管再通率、梗死后心绞痛发作、心力衰竭事件及死亡、再发心肌梗死或脑卒中的联合终点。结果:与A组相比,B组患者溶栓血管再通率显著提高、梗死后心绞痛发作明显减少;而在心力衰竭事件及死亡、再发心肌梗死、或脑卒中的联合终点的比较上差异无显著性意义。2组均无主要和次要出血事件发生,轻微出血发生率无统计学差异。结论:急性ST段抬高的急性心肌梗死患者,不论是否接受择期的冠脉介入治疗(PCI),在标准治疗的基础上早期加用氯吡格雷300mg负荷量,继之75 mg.d~(-1)口服,可显著提高溶栓成功率、降低梗死后心绞痛发作,且安全耐受性好。

Loading Dose of Clopidogrel Therapy in Patients of Acute Myocardial Infarction with ST- Segement Elevation

Objective:To observe the effect and safety of adding loading dose of clopidogrel to standard therapy in the patients of acute myocardial infarction with ST- segement elevation (STEMI).Methods:One hundred and six patients with STEMI within 12 hours were divided into two groups randomly.All the patients were given aspirin 300 mg every day in initial 3 days,and followed by 100 mg daily.Group A wasn't given clopidogrel,while group B was treated with clopidogrel 300mg as soon as they came to the hospital,and then followed by clopidogrel 75mg daily for 30 days.Then the achievement ratio of thrombolysis,attacks of postinfarction angina pec- toris,events of heart failure and composite of death,reinfaretion or stroke were observed.Results:Compared with group A,the patients of group B had significant improvement in the achievement ratio of thrombolysis and obvious reduction in the attacks of postinfarction angina pectofis.There were no events of severe and moderate bleeding in these two groups,and the incidence rate of mild bleeding had no statistics deviation.Conclusion:Adding loading dose of clopidogrel with 300mg,then 75mg daily to standard treatment of acute myo- cardial infarction patients with STEMI,whether to accept percutaneous coronary intervention(PCI)at chosed time or not,can improve the achievement ratio ofthrombolysis and reduce the attacks of postinfarction angina pectoris significantly,with safe and good tolerance.