[摘要]目的 观察在标准治疗的基础上早期应用氯吡格雷对急性心肌梗死溶栓治疗的影响。方法 176例ST段抬高型急性心肌梗死病人随机分为标准组和联合组。两组均接受重组组织型纤溶酶原激活物(rt-PA)溶栓治疗。溶栓前两组均给予阿司匹林300 mg口服，联合组加服氯吡格雷300 mg。溶栓结束后两组均给予阿司匹林300 mg，每天1次，3 d后改为阿司匹林100 mg，每天1次;联合组同时给予氯吡格雷75 mg，每天1次。观察冠状动脉再通率及30 d内再梗死率、梗死后心绞痛发生率及出血、急诊血运重建和心血管死亡事件。结果 联合组冠状动脉再通率高于标准组，再梗死率、梗死后心绞痛发生率、急诊血运重建事件低于标准组，差别有显著性( χ2 = 3.98～ 4.44， P < 0.05);总出血事件、心血管病死亡率两组无显著差别( P >0.05)。结论 溶栓时早期应用氯吡格雷可增加冠状动脉再通率，减少再梗死和梗死后心绞痛的发生，使急诊血运重建事件减少。

    [关键词] 氯吡格雷;心肌梗死;血栓溶解疗法;阿司匹林

    EFFECT OF EARLY APPLICATION OF CLOPIDOGREL ON THROMBOLYTIC THERAPY IN PATIENTS WITH ACUTE MYO-CARDIAL INFARCTION

    ZHOU CHANG-YONG， WANG QI-XIN， GU HUA-LI， et al

    (Emergency Department， The Affili-ated Hospital of Qingdao University Medical College， Qingdao 266003， China)

    [ABSTRACT]ObjectiveTo observe the efficacy of clopidogrel on thrombolytic therapy in patients with acute myocardial in-farction. MethodsThis study consisted of 176 patients with acute ST-segment elevation myocardial infarction who were random-ly divided into standard group and combination group. The patients in both groups received recombinated tissue plasminogen activa-tor (rt-PA) for thrombolysis. Before starting the thrombolysis ......