不同剂量氯吡格雷治疗急性ST段抬高心肌梗死的临床研究

目的:观察标准治疗基础上联合不同剂量氯吡格雷治疗急性ST段抬高心肌梗死的疗效及安全性。方法:2004年9月至2008年3月就诊我院的124例12小时以内发病的ST段抬高型心肌梗死患者,随机分为3组,3组均在入院后前3天给予阿司匹林300mg/d,此后给予阿司匹林100mg/d,A组常规不给予氯吡格雷治疗,B组给予氯吡格雷75mg/d,C组入院即刻给予氯吡格雷300mg,继之75 mg/d治疗,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、C组患者溶栓成功率提高、梗死后心绞痛发作减少。P<0.05:进一步分析发现C组与B组差异无统计学意义,P>0.05。三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,P<0.05。结论:ST段抬高的急性心肌梗死患者在标准治疗的基础上早期加用氯吡格雷75 mg/d或先予300 mg负荷量,继之75 mg/d口服,均可提高溶栓成功率,降低梗死后心绞痛发生,而氯吡格雷负荷剂量组并不优于普通剂量组,且两组安全耐受性好。

Clinical Study on Different Dose of Clopidogrel Therapy in Patients of Acute Myocardial Infarction with ST-Segment Elevation

Objective:To observe the effect and safety of different dose of clopidogrel in standard therapy in Acute Myocardial In- farction with ST-Segment Elevation (STEMI).Method:124 patients who were admitted to our hospital from September 2004 to March 2008 with STEMI within 12 hours were divided into three groups randomly.All patients were given aspirin 300 mg/d for initial 3 days, and then 100 mg daily.The patients in group A weren't given clopidogrel in usual,while those in group B were treated with clopidogrel 75mg daily,and those in group C were treated with clopidogrel 300mg as soon as they were admitted to the hospital and then were treat- ed with clopidogrel 75mg daily.The treatment was continued for 30 days.Achievement ratio of thrombolysis,attacks of post infarction angina pectoris,events of heart failure and composite end of death,reinfarction or stroke were observed.Results:Compared with group A,the achievement ratio of thrombolysis improved and attacks of post infarction angina pectoris reduced in group B and group C,P<0. 05.There was no significative difference between group C and group B.There were no incidence of moderate and severe bleeding in these three groups,and the incidence of mild bleeding had no statistics deviation.Conclusions:In the therapy of acute STEMI,adding clopidogrel 75mg daily or a 300rag loading dose followed by daily dose of 75mg to standard treatment,can improve the achievement ra- tio ofthrombolysis and reduce the attacks of post infarction angina pectoris.The effect of loading dose clopidogrel is not better than the common dose,and both are well tolerated.