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目的探讨大负荷量氯吡格雷在急性心肌梗死(acute myocardial infarction,AMI)患者行直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗时的应用效果。方法把60例AMI患者随机分为常规负荷量(300mg)组和大负荷量(600mg)组,每组30例,入院后立即服用氯吡格雷,分别于服药前、服药后2h、4h取血以比浊法测定血小板最大聚集率;观察患者4周内有无严重出血、粒细胞减少、血小板减少等严重不良反应;观察血管开通时冠状动脉心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血流分级及4周内心脏缺血事件。结果与服药前比较,服药后4h2组血小板最大聚集率都明显降低,但在服药后2h仅有大负荷量组明显降低;随访4周,大负荷量组发生慢血流或无血流2例,无死亡及支架内血栓形成病例;常规负荷量组发生慢血流或无血流7例,亚急性支架内血栓形成1例,死亡1例。2组均无严重出血,粒细胞减少、血小板减少等严重不良反应。结论与常规负荷量相比,大负荷量氯吡格雷能改善AMI患者行直接PCI治疗后早期的血小板拮抗不足,且不增加严重副作用。
Objective To investigate the effect of high-dose clopidogrel in patients undergoing acute percutaneous coronary intervention (PCI) with acute myocardial infarction (AMI). Methods Sixty patients with AMI were randomly divided into normal load (300mg) group and heavy load (600mg) group, 30 patients in each group. Clopidogrel was taken immediately after admission, and blood was taken before taking medicine and 2h and 4h after taking medicine The maximal aggregation rate of platelets was determined by turbidimetric method. Serious adverse reactions such as severe hemorrhage, neutropenia and thrombocytopenia were observed within 4 weeks. Thrombolysis in myocardial infarction (TIMI) Flow classification and 4-week ischemic events. Results Compared with those before treatment, the maximal aggregation rate of platelets in 4h2 group was significantly decreased, but only in the heavy load group at 2h after taking the medicine. The rats in the high-load group showed slow or no blood flow in 2 weeks , No death and stent thrombosis cases; conventional load group occurred slow or no blood flow in 7 cases, subacute stent thrombosis in 1 case, 1 died. No severe bleeding, neutropenia, thrombocytopenia and other serious adverse reactions were found in both groups. Conclusion Compared with conventional loading, high loading clopidogrel can improve the early platelet antagonism in patients with AMI after direct PCI without increasing the serious side effects.