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目的比较静脉与口服阿司匹林给药在急性冠状动脉综合征(ACS)急性期治疗的临床效果,观察静脉阿司匹林的不良反应及6个月临床事件。方法符合诊断标准如不稳定性心绞痛或急性心肌梗死的患者99例,入院前均服用口服阿司匹林100 mg/d 至少1周以上。采用随机前瞻性对照研究,按随机区组设计方法将符合入选标准的患者随机分到三组,排除自动转院及失访者,最后静脉(300 mg/d)组30例,口服(100 mg/d)组32例、口服(300 mg/d)组33例。对照组20例为无器质性心脏病及血液病从未服用过阿司匹林及氯吡格雷的患者。结果静脉组二磷酸腺苷(ADP)诱导血小板聚集率降低幅度为(12.0±10.4)%,与口服(100 mg/d)组的(6.0±14.6)%及口服(300 mg/d)组的(9.4±16.6)%比较差异无统计学意义;静脉组花生四烯酸(AA)诱导血小板聚集率降低幅度为(6.7±11.2)%,与口服(100 mg/d)组的(6.9±12.3)%及口服(300 mg/d)组的(7.3±13.0)%比较,差异无统计学意义。静脉组 CD62p 水平降低幅度(10.9±18.6)%,与口服(100 mg/d)组的(9.0±11.8)%及口服(300 mg/,d)组的(7.1±15.7)%比较差异无统计学意义。6个月随访结果:静脉组出现临床终点事件3例(10.0%),口服(100 mg/d)组和口服(300 mg/d)组分别为3例(9.4%)和4例(12.1%),三组比较差异无统计学意义。结论阿司匹林静脉(300 mg/d)与口服(100 mg/d,300 mg/d)途径在 ACS 急性期1周应用对 ADP、AA 诱导的血小板聚集率及血小板 CD62p水平降低幅度的影响无明显差异。静脉用药可减少消化道黏膜的直接刺激,能够替代不能口服阿司匹林的 ACS 患者的抗血小板治疗。
Objective To compare the clinical effects of intravenous and oral aspirin in the acute phase of acute coronary syndrome (ACS) and to observe the adverse reactions of intravenous aspirin and the clinical events of 6 months. Methods Ninety-nine patients with diagnostic criteria such as unstable angina or acute myocardial infarction were treated with oral aspirin 100 mg / day for at least 1 week prior to admission. Randomized prospective randomized controlled study was conducted in randomized block design. Patients who met the inclusion criteria were randomized into three groups: 30 patients in the final intravenous (300 mg / d) group and 100 mg / 32 patients in group d) and 33 patients in oral (300 mg / d) group. Twenty patients in the control group were those who had never taken aspirin and clopidogrel without organic heart disease and blood disease. Results The reduction rate of platelet aggregation induced by adenosine diphosphate (ADP) was (12.0 ± 10.4)% in the intravenous group compared with 6.0 ± 14.6% and 100 mg / d in the oral administration group (9.4 ± 16.6)%, while the reduction of platelet aggregation induced by arachidonic acid (AA) was (6.7 ± 11.2)% in intravenous group and (6.9 ± 12.3) in oral group ) And oral (300 mg / d) group (7.3 ± 13.0)%, the difference was not statistically significant. There was no significant difference in the level of CD62p in venous group (10.9 ± 18.6)%, (9.0 ± 11.8)% in oral group (100 mg / d) and 7.1 ± 15.7% (0.3 ± 11.7%) in oral group Significance of learning. Results of 6-month follow-up were: 3 cases (10.0%) in the intravenous group and 3 cases (9.4%) and 4 cases (12.1%) in the oral group (100 mg / d) ), No significant difference between the three groups. CONCLUSIONS: There is no significant difference in the effect of aspirin intravenous (300 mg / d) and oral (100 mg / d, 300 mg / d) once a week on the ADP, AA induced platelet aggregation and the decrease of platelet CD62p . Intravenous administration can reduce the direct stimulation of the digestive tract mucosa, can replace anti-platelet therapy in ACS patients who can not take aspirin.