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目的:对比研究拟行急诊冠脉介入治疗(PCI)患者术前服用超负荷量氯吡格雷(600 mg)与常规负荷量(300 mg)预处理的近期疗效及安全性。方法:选择2007年1月至2009年12月行急诊PCI治疗的急性心肌梗死患者60例,随机分为常规负荷量组(300 mg,n=30)和超负荷量组(600 mg,n=30),入院后两组立即分别服用氯吡格雷300 mg和600 mg。观察术后28天内主要临床心血管事件(包括亚急性支架内血栓形成、死亡、心肌梗死、紧急靶血管血运重建)和出血事件。结果:氯吡格雷600 mg组28天主要心血管事件发生率较300 mg组显著减少(3.3%vs 20.0%,P<0.05),而两组28天出血事件发生率无显著差异(20.0%vs13.3%,P>0.05)。结论:超负荷量氯吡格雷(600 mg)预治疗与常规负荷量(300 mg)相比,可显著改善急性心肌梗死行急诊PCI患者的近期疗效,且安全性相似。
OBJECTIVE: To compare the short-term efficacy and safety of pre-treatment with clopidogrel (600 mg) and conventional loading (300 mg) before PCI in patients undergoing emergency PCI. Methods: Sixty patients with acute myocardial infarction who underwent emergency PCI from January 2007 to December 2009 were randomly divided into routine load group (300 mg, n = 30) and overload group (600 mg, n = 30), two groups immediately after admission were taken clopidogrel 300 mg and 600 mg. Major clinical cardiovascular events (including subacute stent thrombosis, death, myocardial infarction, emergency target revascularization) and bleeding events were observed within 28 days of surgery. Results: The incidence of major cardiovascular events at 28 days in clopidogrel 600 mg group was significantly lower than that in 300 mg group (3.3% vs 20.0%, P <0.05), while there was no significant difference in 28-day bleeding between the two groups (20.0% vs 13 .3%, P> 0.05). Conclusions: Compared with conventional loading (300 mg), pretreatment with overloaded clopidogrel (600 mg) significantly improves the short-term efficacy of emergency PCI in patients with acute myocardial infarction with similar safety.