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目的探讨不同氯吡格雷在冠脉造影术前及术中负荷方式与剂量对中低危急性冠脉综合症(ACS)患者支架植入术后发生不良心血管事件的影响。方法入选279名患者,对照组114名患者,随机分为术前大于6小时氯吡格雷300mg负荷组65人、术中氯吡格雷300mg负荷组60人及术中氯吡格雷600mg负荷组40人。主要观察终点为术后30天内主要不良心血管事件(MACE)。结果各组间MACE事件发生无统计学差异(P=0.45);各组间ADP诱导最大血小板聚集率(ADP-PG)(P=0.05)和血清P-选择素(P=0.06)无统计学差异;术后均未出现大出血,术中600mg组出血发生率有升高趋势(P=0.28);支架平均直径(P=0.03)、术后TIMI血流分级(P=0.02)和术后最大ADP-PG(P=0.01)与MACE事件相关,而负荷方式、负荷剂量以及随访最大ADP-PG等与随访MACE无关。结论氯吡格雷术中负荷方式与术前负荷临床终点相似,600mg负荷剂量未进一步增加患者临床获益,且小出血发生有增加的趋势;如临床需要,在了解了患者冠脉情况后再予氯吡格雷负荷是一个安全且可以考虑的方法。
Objective To investigate the effect of different clopidogrel on adverse cardiovascular events after stent implantation in patients with moderate and low risk acute coronary syndrome (ACS) before and during coronary angiography. Methods A total of 279 patients and 114 patients in the control group were randomly divided into preoperation clopidogrel 300mg load group 65 patients, intraoperative clopidogrel 300mg load group 60 and intraoperative clopidogrel 600mg load group 40 . The primary end point was major adverse cardiovascular event (MACE) within 30 days after surgery. Results There was no significant difference in MACE events between groups (P = 0.45). ADP-induced maximal platelet aggregation (ADP-PG) and serum P-selectin (P = 0.28); average diameter of stent (P = 0.03), postoperative TIMI flow classification (P = 0.02) and postoperative maximum ADP-PG (P = 0.01) was associated with MACE events, whereas loading patterns, loading dose, and maximum ADP-PG follow-up were independent of MACE follow-up. Conclusion The loading mode of clopidogrel surgery is similar to that of preoperative load. The 600 mg loading dose did not further increase the clinical benefit, and the incidence of small bleeding increased. If the clinical needs, Clopidogrel loading is a safe and well-considered method.