急性冠状动脉综合征论文：急性冠脉综合征病人早期血小板聚集与预后的关系探讨.docVIP

急性冠状动脉综合征论文：急性冠脉综合征病人早期血小板聚集与预后的关系探讨 【中文摘要】探讨急性冠脉综合征病人在常规抗凝、抗血小板聚集治疗基础上,观察应用血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班对病人预后影响以及血小板聚集率下降水平与预后相关性。方法本研究对吉林省人民医院2009年3月至2010年9月间收治的符合急性冠脉综合征诊断的共80例患者。男性为42例,女性为38例,年龄34-68岁,平均59.07±9.29岁。合并高血压者50例,合并糖尿病者37例,既往有长期吸烟史者39例。随机分为标准治疗组(n=42)和替罗非班组(n=38)。标准治疗组给予阿司匹林+氯比格雷+低分子肝素；替罗非班组在上述药物基础上给予静脉负荷量0.4ug/(kg?min)30 min,然后以维持量0.1ug/(kg?min),微量泵持续泵入替罗非班,疗程24-48小时。观察2组血小板聚集率下降水平及达标时间进行测定,及病人预后血清肌钙蛋白的变化评估。结果1.替罗非班组血小板聚集率在就诊后90分钟内谷值水平达标；标准治疗组就诊后2小时内谷值水平达标,替罗非班组谷值水平时间明显提前于标准治疗组,有统计学差异。2.替罗非班组肌钙蛋白I (cTnI)峰值水平及12-24-48小时水平均明显低于标准治疗组,有统计学差异。3.替罗非班组较标准治疗组24小时及30天患者心脑血管终点事件率有下降趋势,但无统计学意义,均未见较严重并发症,仅有个别表现为牙龈出血、皮下淤斑、血尿及鼻出血。4、两组均未见有血小板减少,两者之间出血并发症发生率差异无统计学意义。结论早期应用血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班能明显抑制血小板聚集,治疗急性冠脉综合征是安全有效的。 【英文摘要】:To explore the application of glycoprotein (GP)Ⅱb/Ⅲa receptor blockade tirofiban on the prognosis influence and the correlation between platclet aggregation rate(PAR)decreasing level and the prognosis in patients with acute coronary syndrome (ACS)based on conventional therapy of anticoagulation and antiplatelet.Methods:From March 2009 to September 2010,80ACS patients,(42 males,38females,age betwen34-68,mean age 59.07?.29yeats old.50patients complicating with hypertension, 37patients complicating with diabetes,39patients had long-term smoking history) randomlgy divided into standard therapy group(n=42)and tirofiban group(n=38).The standard therapy group had been treated by Aspirin,Clopidogrel and Low Molecular Heparin.The tirofiban qroup had undergone the same treatment as the standard therapy group as well.Moreover,the tirofiban group was applicated by intravenous injection for loading dose 0.4ug/kg.min.for 30minutes,followed by 0.1 ug/kg.min and maintained for a mean of 24-48h.To observe the decreasing level of PAR and the standand time of two groups.To assess the change of Troponin I.Results:The PAR of tirofiban group had reached the standard level within 90 minutes after the treatment.The standard therapy group had reached the standard le