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2005年美国心脏学会(ACC)、美国心脏学会(AHA)和欧洲心脏学会(ESC)修订的PCI指南,围术期心肌梗死的平均发生率分别为(23±12)%、(23±12)%和(27±12)%[1]。主要预防围术期心肌梗死措施是应用抗血小板和抗凝药物治疗以减少血栓形成。作者在临床药学查房的过程中观察到,行PCI术后的患者,常规应用抗血小板和抗凝药物预防血栓形成,预防方案为:术前使用阿司匹林(拜阿司匹林)300mg,1次/d,氯吡格雷(波立维)750mg,1次/d,术后使用阿司匹林300mg,1次/d,共用一个月,后改为100mg,1次/d维持,氯吡格雷75mg,1次/d维持一年,低分子肝素(克塞或速礕凝)0·75～1mg/(kg·h),1次/12h,共3～5d;在上述治疗的基础上根据患者情况加用盐酸替罗非班(欣维宁),起始剂量0·2～0～4ug/(kg·min),30min内静脉滴注,继续以0·05～0·1ug/(kg·min)的速度维持滴注13～26h。有些患者在上述方案中会出现皮肤黏膜、消化道出血的不良反应。查阅我院07年行PCI术的患者病历共202份进行回顾性分析,并结合文献资料对使用抗血小板和抗凝药物的疗效及安全性进行简要评价。
In 2005, the PCI guidelines revised by the American College of Cardiology (ACC), American Heart Association (AHA) and European Society of Cardiology (ESC) showed that the average incidence of perioperative myocardial infarction was (23 ± 12)% and (23 ± 12) % And (27 ± 12)% [1]. The main preventive perioperative myocardial infarction measures are the use of anti-platelet and anticoagulant drugs to reduce thrombosis. The authors observed during the clinical pharmacy rounds of surgery in patients undergoing PCI, antiplatelet and anticoagulant drugs routinely used to prevent thrombosis, prevention programs are: preoperative aspirin (aspirin) 300mg, 1 / d, Clopidogrel 750mg, once a day, aspirin 300mg once a day for one month, then changed to 100mg once a day, clopidogrel 75mg once a day One year, low molecular weight heparin (Kesi or speed 礕 condensate) 0.75 ~ 1mg / (kg · h), 1 / 12h, a total of 3 ~ 5d; on the basis of the above treatment based on the patient’s condition plus ti- Non-class (Xin Weining), the initial dose of 0.2 ~ 0 ~ 4ug / (kg · min), intravenous infusion within 30min, continue to keep the rate of 0 · 05 ~ 0 · 1ug / (kg · min) Note 13 ~ 26h. Some patients in the above program will appear skin and mucous membranes, gastrointestinal bleeding adverse reactions. A retrospective analysis was performed on 202 medical records of patients undergoing PCI in our hospital in 2007 and a brief evaluation of the efficacy and safety of antiplatelet and anticoagulant drugs combined with the literature was conducted.