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目的评价硫酸氢氯吡格雷联合阿司匹林对经皮穿刺冠状动脉介入(PCI)治疗的术后心肌保护作用研究。方法 98例冠心病患者随机分为对照组49例与试验组49例,2组均给予常规治疗以及对症治疗。对照组于术前服用阿司匹林150 mg,试验组以阿司匹林150 mg联合硫酸氢氯吡格雷片75 mg服用,每日1次,持续用药7 d。2组患者进行PCI,术后服用阿司匹林300 mg+硫酸氢氯吡格雷75 mg,每日1次,连续服用3个月。比较2组的临床疗效、治疗前后血清肌酸激酶(CK)、血清谷草转氨酶(AST)、乳酸脱氢酶(LDH)、C-反应蛋白(CRP)、肌钙蛋白T(Tn T)、P-选择素(Ps)、P选择素糖蛋白配体1(PSGL-1)水平以及不良反应发生情况。结果治疗后,对照组临床总有效率为81.63%,显著低于试验组的95.92%(P<0.05)。治疗后,2组的血清肌酸激酶、谷草转氨酶、乳酸脱氢酶水平显著低于治疗前(P<0.05)。与对照组比较,试验组血清肌酸激酶[(741.56±77.45)U·L-1vs(632.42±65.46)U·L~(-1),P<0.05]、谷草转氨酶[(449.24±50.64)U·L~(-1)vs(362.46±40.72)U·L~(-1),P<0.05]、乳酸脱氢酶[(500.24±51.42)U·L~(-1)vs(426.87±45.73)U·L~(-1),P<0.05]水平均显著降低(P<0.05);血清C-RP、Tn T、Ps、PSGL-1水平均显著降低,但试验组显著小于对照组(P<0.05)。对照组不良反应发生率为16.33%,试验组为6.12%,但差异无统计学意义(P>0.05)。结论硫酸氢氯吡格雷联合阿司匹林术前使用,对PCI术后的心肌保护作用良好,临床疗效显著,安全性较高。
Objective To evaluate the postoperative myocardial protective effect of clopidogrel bisulfate combined with aspirin on percutaneous coronary intervention (PCI). Methods A total of 98 patients with coronary heart disease were randomly divided into control group (n = 49) and experimental group (n = 49). Both groups were given routine treatment and symptomatic treatment. The control group took aspirin 150 mg preoperatively and the test group took aspirin 150 mg and 75 mg clopidogrel hydrogen sulfate tablets once daily for 7 days. Two groups of patients undergoing PCI were given aspirin 300 mg and clopidogrel hydrogen sulfate 75 mg once daily for 3 months. The clinical effects of two groups were compared before and after treatment. Serum creatine kinase (CK), serum aspartate aminotransferase (AST), lactate dehydrogenase (LDH), C-reactive protein (CRP), troponin T - selectin (Ps), P-selectin glycoprotein ligand 1 (PSGL-1) levels and the incidence of adverse reactions. Results After treatment, the total effective rate of the control group was 81.63%, which was significantly lower than that of the experimental group (95.92%, P <0.05). After treatment, the levels of serum creatine kinase, aspartate aminotransferase, and lactate dehydrogenase in the two groups were significantly lower than those before treatment (P <0.05). Compared with the control group, serum creatine kinase [(741.56 ± 77.45) U · L-1vs (632.42 ± 65.46) U · L -1, P <0.05] and aspartate aminotransferase [(449.24 ± 50.64) U · L -1 vs 362.46 ± 40.72 U · L -1, P <0.05], lactate dehydrogenase [(500.24 ± 51.42) U · L -1 vs (426.87 ± 45.73 (P <0.05). The levels of C-RP, Tn T, Ps and PSGL-1 in serum were significantly lower than those in control group (P <0.05) P <0.05). The incidence of adverse reactions in the control group was 16.33%, while the experimental group was 6.12%, but the difference was not statistically significant (P> 0.05). Conclusions The preoperative use of clopidogrel bisulfate combined with aspirin has a good protective effect on myocardial after PCI. The clinical effect is significant and the safety is high.