应用血栓弹力图指导PCI术后三联抗血小板药物方案实施可行性分析.docVIP

应用血栓弹力图指导PCI术后三联抗血小板药物方案实施可行性分析 　　【摘要】 目的 探讨经皮冠状动脉介入治疗(PCI)患者中,应用血栓弹力图(TEG)所测定的血小板抑制率的达标情况,以指导是否予以在经典的二联抗血小板药物基础上加用培达的三联抗血小板药物的可行性。方法 回顾分析342例冠脉支架植入术患者,术后均为常规方法予抗血小板药物,根据应用美国Hamoscope公司的TEG分析仪测定其ADP途径诱导的血小板抑制率值,将其分为抑制率达标组,及抑制率未达标组,未达标组随机分为2组,其中1组为在硫酸氢氯吡格雷(波利维)及阿司匹林基础上加用培达(即三联抗血小板组)。另1组为二联抗血小板组。3组患者均予3个月随访,以确定不良缺血事件的发生。结果 血小板抑制率达标组的不良心脑血管缺血事件发生率为(2/226)%,二联抗血小板组的不良心脑血管缺血事件发生率为(3/34)%,二者比较差异有统计学意义。三联抗血小板组不良心脑血管缺血事件发生为0例,与二联抗血小板组的3例比较,二联抗血小板组缺血事件发生有增多趋势,但二者比较差异无计学意义。结论 血栓弹力图(TEG)测定的血小板抑制率对于冠脉支架植入术后患者的抗血小板药物治疗方案的选择有一定的指导意义。 　　【关键词】 血栓弹力图;血小板; 血小板抑制率;经皮冠状动脉;介入治疗 　　 　　The feasibility analysis for practice of post coronary stenting triple antiplatelet therapies by thrombelastography 　　 　　WANG Fang,CHI Yun-peng.Departm ent of Cardiology,General Hospital of Fushun Mining Group,Liaoning113000,China 　　 　　【Abstract】 Objective To explore the objective status of platelet inhibition ratio determined by thrombelastography(TEG)in patients undergoing percutaneous coronary intervention(PCI),in order to analyze the feasibility of dual antiplatelet drugs combined with pletaal.Methods 342 elective PCI patients who were prescribed with aspirin and clopidogrel were studied with TEG(Hamoscope,USA)to determine platelet inhibition ratio(PIR)induced by AA and ADP.On the basis of the results,all the patients were divided to two groups which is appropriate to the standard or not.And the appropriate group is randomized to two parts receiving either triple antiplatelet drugs of aspirin and clopidogrel combined with cilostazol or dual antiplatelet drugs of aspirin and clopidogrel.All 3 groups were received 6-month clinical follow-up to definite adverse ischemia events.Results The incidence rate of ischemia events of dual antiplatelet drugs has statistically significant difference.The different incidence rate of ischemia events between triple antiplatelet drugs and dual antiplatelet drugs is not statistically significant,but the dual antiplatelet drugs group has growing tendency.Conclusion