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目的:观察抗血小板联合抗凝治疗预防糖尿病下肢动脉硬化闭塞症(LASO)支架植入后再狭窄的的临床疗效及安全性。方法:接受血管内支架植入术的糖尿病LASO患者83例随机分为观察组42例和对照组41例,每组患肢均为49条。对照组在术后口服氯吡格雷75 mg+阿司匹林肠溶片100 mg,观察组在此基础上加用低分子肝素(INR达2.0~3.0后停用)和华法林(6个月),术后随访12个月,比较两组患者患肢的再狭窄发生情况及用药安全性。结果:治疗后,两组患者空腹血糖、糖化血红蛋白、总胆固醇和低密度脂蛋白等指标在各时点比较,差异无统计学意义(P>0.05)。术后12个月,观察组最小腔内直径(MLD)明显大于对照组(P<0.05),再狭窄发生率(RR)明显低于对照组(P<0.05),血浆D-二聚体(D-D)水平较对照组明显下降(P<0.05)。两组出血事件发生率(BR)比较无明显差异(P>0.05)。结论:相对于单独应用抗血小板治疗,抗凝联合抗血小板治疗能够更加有效的预防糖尿病下肢动脉硬化闭塞症患者支架植入术后血管再狭窄的发生,且安全性较好,值得临床推广。
Objective: To observe the clinical efficacy and safety of antiplatelet combined with anticoagulant therapy in prevention of restenosis after stent implantation of diabetic lower extremity arteriosclerosis obliterans (LASO). Methods: Eighty-three diabetic LASO patients undergoing stent implantation were randomly divided into observation group (n = 42) and control group (n = 41), with 49 limbs in each group. In the control group, 100 mg of clopidogrel and aspirin enteric-coated tablets were given orally. Low-molecular-weight heparin (INR 2.0 to 3.0) and warfarin (6 months) were used in the observation group. After a follow-up of 12 months, the incidence of restenosis and drug safety in the two groups were compared. Results: After treatment, the fasting blood glucose, glycosylated hemoglobin, total cholesterol and low density lipoprotein were not significantly different between the two groups at all time points (P> 0.05). At 12 months after operation, the minimum intraluminal diameter (MLD) in the observation group was significantly larger than that in the control group (P <0.05), and the incidence of restenosis was significantly lower than that in the control group (P <0.05) DD) was significantly lower than the control group (P <0.05). There was no significant difference in bleeding rate (BR) between the two groups (P> 0.05). CONCLUSION: Compared with antiplatelet therapy alone, anticoagulation combined with antiplatelet therapy is more effective in preventing restenosis after stent implantation in patients with diabetic lower extremity arterial occlusive disease and is safe and worthy of clinical promotion.