杜玉斌 李丹 黄思兵

    [摘要] 目的 應用血栓弹力图(TEG)监测冠心病患者经皮冠状动脉介入(PCI)术后应用抗血小板药物的效果，分析其与PCI术后患者缺血和出血事件的关系。 方法 收集2017年7月～2018年5月广东省惠州市第一人民医院(以下简称“我院”)诊断为冠心病并行PCI治疗的患者300例，均予阿司匹林和氯吡格雷进行双联抗血小板治疗，以血小板花生四烯酸(AA)途径血小板聚集抑制率≥50%定义阿司匹林起效，二磷酸腺苷(ADP)途径血小板聚集抑制率≥30%定义氯吡格雷起效。根据TEG AA/ADP抑制率结果分为阿司匹林+氯吡格雷起效组(AA及ADP抑制率均达标)200例，阿司匹林未起效组30例，氯吡格雷未起效组50例，阿司匹林+氯吡格雷未起效组20例。比较四组的血小板抑制率及随访半年内的缺血事件总发生率。根据TEG中二磷酸腺苷诱导最大血块强度(MA-ADP)结果分为MA-ADP47 mm组，比较三组的血小板抑制率、出血事件总发生率。 结果 四组患者的血小板抑制率、缺血事件总发生率比较，差异有统计学意义(P < 0.05)。阿司匹林+氯吡格雷起效组血小板抑制率最高，显著高于其他各组(P < 0.05)。阿司匹林+氯吡格雷未起效组的缺血事件总发生率达35.00%，显著高于其他各组(P < 0.05)。将纳入的300例患者按照TEG MA-ADP结果分为MA-ADP47 mm组，三组患者血小板抑制率、出血事件总发生率比较，差异有统计学意义(P 47 mm组的血小板抑制率显著低于其他两组(P 47 mm组的出血事件总发生率仅5%，显著低于其他两组(P 47 mm group. The platelet inhibition rate and the total incidence of bleeding events were compared among the three groups. Results The platelet inhibition rate and the total incidence of ischemic events in the four groups were significantly different (P 47 mm group according to the results of TEG MA-ADP. The platelet inhibition rate and the total incidence of hemorrhagic events in the three groups were significantly different (P 47 mm group was significantly lower than that of other two groups (P 47 mm group was only 5% ......