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目的观察标准治疗基础上联合氯吡格雷治疗60岁以上急性ST段抬高心肌梗死患者1年疗效及安全性。方法 95例72 h以内发病60岁以上的ST段抬高心肌梗死患者随机分为两组,两组均在入院后前3 d给予阿司匹林300 mg/d,此后给予阿司匹林100 mg/d,对照组中患者给予氯吡格雷治疗(75 mg/d,持续15 d)。观察组患者入院即刻给予氯吡格雷300 mg,继之75 mg/d治疗1年。观察心绞痛发作、心力衰竭事件及死亡、再发心肌梗死、或脑卒中的联合终点。结果与对照组相比,观察组患者心绞痛发作减少,死亡、再发心肌梗死或脑卒中的联合终点下降(P<0.05)。两组轻微出血发生率无统计学差异(P>0.05),两组均无严重出血事件发生。结论 60岁以上ST段抬高的急性心肌梗死患者,不论是否接受早期溶栓治疗,在标准治疗的基础上早期加用氯吡格雷300 mg负荷量,继之75 mg/d口服,治疗1年,可降低心绞痛的发作及死亡、再发心肌梗死、或脑卒中的联合终点,且安全耐受性好。
Objective To observe the standard treatment of clopidogrel in patients over the age of 60 acute ST-elevation myocardial infarction in patients with 1 year efficacy and safety. Methods Ninety-five patients with ST-segment elevation myocardial infarction over 60 years old within 72 hours were randomly divided into two groups. The two groups were given aspirin 300 mg / d three days before admission, then aspirin 100 mg / d, and the control group Patients were given clopidogrel (75 mg / d for 15 days). Patients in the observation group were given clopidogrel 300 mg immediately after admission, followed by 75 mg / d for 1 year. To observe the onset of angina pectoris, heart failure and death, recurrent myocardial infarction, or stroke combined endpoint. Results Compared with the control group, the patients in the observation group had decreased angina attacks, decreased the combined endpoint of death, recurrent myocardial infarction or stroke (P <0.05). No significant difference was found in the incidence of mild bleeding between the two groups (P> 0.05). No severe bleeding occurred in either group. Conclusions Patients with ST-elevation acute myocardial infarction over the age of 60 with or without initial thrombolytic therapy were initially treated with clopidogrel 300 mg, followed by 75 mg / day orally for 1 year on standard therapy , Can reduce the onset and death of angina pectoris, recurrence of myocardial infarction, or stroke combined endpoint, and good safety tolerance.