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目的:对比观察拟行冠状动脉(冠脉)介入术患者术前服用高负荷剂量氯吡格雷600mg与常规负荷剂量300mg预治疗的有效性及安全性。方法:选取100例拟行冠脉介入术的患者,术前随机分别给予600mg(50例)或300mg(50例)负荷剂量氯吡格雷预治疗。分别检测2组服药前、服药后16、36h二磷酸腺苷(ADP)诱导的血小板最大凝集率(MPAR),随访术后30d和6个月主要临床心血管事件(包括死亡、心肌梗死、紧急靶血管血运重建、脑卒中等)和出血事件的发生情况。结果:服药后16h,氯吡格雷600mg组较之300mg组对ADP(5μmol/L和20μmol/L)诱导的MPAR产生更大的抑制作用[ADP5μmol/L,(21·83±18·04)%∶(14·79±9·18)%,P<0·05];[ADP20μmol/L,(22·12±14·81)%∶(15·67±10·15)%,P<0·05)]。而服药后36h,2组ADP(5μmol/L和20μmol/L)诱导的MPAR率分别降低[ADP5μmol/L,(16·70±15·42)%∶(12·94±10·34)%,P>0·05]和[20μmol/L∶(14·14±13·16)%:(10·19±9·49)%,P>0·05]。氯吡格雷600mg组30d和6个月主要临床心血管事件发生率较300mg组显著减少(P<0·05,P<0·01)。2组30d和6个月出血事件差异均无统计学意义。结论:冠脉介入术患者术前服用高负荷剂量氯吡格雷600mg较之常规负荷剂量300mg预治疗能更大程度抑制血小板凝集,同时可显著改善临床预后。
OBJECTIVE: To compare the efficacy and safety of pre-treatment with high-loading clopidogrel 600 mg and conventional loading 300 mg in patients undergoing coronary artery (PCI) coronary intervention. Methods: A total of 100 patients undergoing PCI were enrolled. Patients were pretreated with clopidogrel 600 mg (50 cases) or 300 mg (50 cases) preoperatively. The maximum platelet aggregation rate (MPAR) induced by adenosine diphosphate (ADP) at 16 and 36 h after taking the drug was measured before and after treatment, and the main clinical cardiovascular events (including death, myocardial infarction, emergency Target vessel revascularization, stroke, etc.) and the occurrence of bleeding events. Results: After 16 h, the clopidogrel 600 mg group had a greater inhibitory effect on the MPAR induced by ADP (5 μmol / L and 20 μmol / L) than the 300 mg group [ADP5 μmol / L, (21.83 ± 18.04)%] : (14.79 ± 9.18)%, P <0.05]; [ADP20μmol / L, (22.12 ± 14.81)%: (15.67 ± 10.15)%, P < 05)]. After 36 h, the MPAR rates induced by ADP (5μmol / L and 20μmol / L) were decreased in ADP5μmol / L, (16 · 70 ± 15 · 42)%: (12 · 94 ± 10 · 34)%, P> 0.05] and [20μmol / L: (14.14 ± 13.16)% :( 10.19 ± 9.49)%, P> 0.05. The incidence of major clinical cardiovascular events at 30 and 6 months in clopidogrel 600 mg group was significantly lower than that in 300 mg group (P <0.05, P <0.01). There was no significant difference in bleeding events between the two groups at 30d and 6 months. CONCLUSION: Preoperative administration of high-loading clopidogrel 600 mg compared with conventional loading of 300 mg pre-treatment in patients undergoing PCI can inhibit platelet aggregation to a greater extent and significantly improve clinical outcomes.