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目的观察替罗非班注射剂对氯吡格雷抵抗性急性冠状动脉综合征患者介入治疗的临床疗效及安全性。方法将54例氯吡格雷抵抗性急性冠状动脉综合征患者随机分为对照组27例和试验组27例。对照组术后予以口服氯吡格雷150 mg qd,10 d后改为75 mg qd;试验组术中予以静脉推注替罗非班10μg·kg~(-1)后,以0.1μg·kg~(-1)·min~(-1)的速度静脉泵注48 h,术后口服氯吡格雷75 mg qd。2组患者均治疗15 d。比较2组患者的血小板颗粒表面膜糖蛋白(CD62p)、血小板膜糖蛋白Ⅱb-Ⅲa复合物纤维蛋白原受体(PAC-1)水平,以及药物不良反应的发生情况。结果治疗后,试验组和对照组的CD62p分别为(3.26±0.43)%,(7.98±1.14)%;PAC~(-1)分别为(3.42±0.37)%,(7.88±1.09)%,差异均有统计学意义(P<0.05)。2组患者的药物不良反应以死亡、心血管不良事件和出血为主,且试验组和对照组的药物不良反应发生率分别为11.11%和40.74%,差异有统计学意义(P<0.05)。结论替罗非班注射剂能显著降低氯吡格雷抵抗性急性冠状动脉综合征介入治疗患者的CD62p及PAC-1水平,减少心血管不良事件的发生率,且不增加出血并发症的发生率。
Objective To observe the clinical efficacy and safety of tirofiban injection in the interventional therapy of clopidogrel resistant acute coronary syndrome patients. Methods Fifty-four patients with clopidogrel-resistant acute coronary syndrome were randomly divided into control group (n = 27) and experimental group (n = 27). The control group was given oral clopidogrel 150 mg qd postoperatively and changed to 75 mg qd after 10 days. The patients in trial group were treated with intravenous tirofiban 10 μg · kg -1, (-1) · min ~ (-1) for 48 h after intravenous injection of clopidogrel 75 mg qd postoperatively. Two groups of patients were treated for 15 days. The levels of CD62p, PAC-1, and ADRs in the two groups were compared. Results After treatment, the CD62p values in the test group and the control group were (3.26 ± 0.43)% and (7.98 ± 1.14)%, respectively. The PAC ~ (-1) were 3.42 ± 0.37% and 7.88 ± 1.09% All were statistically significant (P <0.05). Adverse drug reactions in two groups were mainly death, cardiovascular adverse events and bleeding. The incidences of adverse drug reactions in the two groups were 11.11% and 40.74%, respectively, with significant differences (P <0.05). Conclusion Tirofiban injection can significantly reduce the levels of CD62p and PAC-1 in patients receiving clopidogrel-resistant acute coronary syndromes, reduce the incidence of cardiovascular adverse events, and do not increase the incidence of bleeding complications.