CAJ | 학술논문

目的评价强化抗栓治疗(阿司匹林、氯吡格雷联合替罗非班)高龄(≥75岁)非ST段抬高型急性冠状动脉综合征(NSTEACS)患者的有效性和安全性.方法入选高龄NSTEACS患者146例,按随机数字表法分为观察组(70例)和对照组(76例).对照组给予阿司匹林、低分子量肝素、氯吡格雷等常规治疗;观察组在常规治疗基础上加用替罗非班[静脉负荷量0.4μg/(kg· min),30 min后以0.1μg/(kg·min)维持,持续48～ 72 h].观察两组患者30d主要心血管事件(MACE)、7d心绞痛症状缓解程度及出血等不良反应的发生情况.结果观察组30 d的MACE发生率为5.7％(4/70),对照组为14.5％(11/76),两组比较差异有统计学意义(P＜0.05).观察组与对照组7d心绞痛症状缓解总有效率分别为92.9％(65/70)和76.3％(58/76),差异有统计学意义(P＜0.05).观察组与对照组出血发生率分别为10.0％(7/70)和7.9％(6/76),差异无统计学意义(P＞0.05).两组均无严重的出血并发症,观察组发生1例血小板减少,但与对照组比较差异无统计学意义(P＞0.05).结论替罗非班强化抗栓治疗高龄NSTEACS患者,能有效缓解心绞痛症状,降低30 d的MACE发生率,不增加出血风险.
목적 평개강화항전치료(아사필림、록필격뢰연합체라비반)고령(≥75세)비ST단태고형급성관상동맥종합정(NSTEACS)환자적유효성화안전성.방법 입선고령NSTEACS환자146례,안수궤수자표법분위관찰조(70례)화대조조(76례).대조조급여아사필림、저분자량간소、록필격뢰등상규치료;관찰조재상규치료기출상가용체라비반[정맥부하량0.4μg/(kg· min),30 min후이0.1μg/(kg·min)유지,지속48～ 72 h].관찰량조환자30d주요심혈관사건(MACE)、7d심교통증상완해정도급출혈등불량반응적발생정황.결과 관찰조30 d적MACE발생솔위5.7％(4/70),대조조위14.5％(11/76),량조비교차이유통계학의의(P＜0.05).관찰조여대조조7d심교통증상완해총유효솔분별위92.9％(65/70)화76.3％(58/76),차이유통계학의의(P＜0.05).관찰조여대조조출혈발생솔분별위10.0％(7/70)화7.9％(6/76),차이무통계학의의(P＞0.05).량조균무엄중적출혈병발증,관찰조발생1례혈소판감소,단여대조조비교차이무통계학의의(P＞0.05).결론 체라비반강화항전치료고령NSTEACS환자,능유효완해심교통증상,강저30 d적MACE발생솔,불증가출혈풍험.
Objective To evaluate the safety and efficacy of radical antithrombotic therapy(aspirin,clopidogrel and tirofiban) in the treatment of senile (≥ 75 years) non-ST-elevation acute coronary syndrome (NSTEACS).Methods A total of 146 senile patients with NSTEACS were divided into observation group (70 cases) and control group(76 cases) by random digits table method.The control group was given aspirin,low molecular weight heparin and clopidogrel,and the observation group was added tirofiban (intravenous loading dosage:0.4 μ g/ (kg· min) for 30 min and then maintaining 0.1 μ g/ (kg· min) for 48-72 h).The occurrence of major adverse cardiovascular events (MACE) within 30 d after treatment,7 d angina pectoris control rate and adverse reactions were observed in two groups.Results The occurrence rate of MACE within 30 d after treatment was 5.7％ (4/70) in observation group,and 14.5％ (11/76) in control group,and there was significant difference (P ＜ 0.05).The 7 d angina pectoris control rate was 92.9％ (65/70) and 76.3 ％ (58/76) in observation group and control group,and there was significant difference (P ＜ 0.05).The incidence of bleeding was 10.0 ％ (7/70) and 7.9 ％ (6/76) in observation group and control group,and there was no significant difference (P ＞ 0.05).There were no major bleeding events in two groups.One case had thrombocytopenia in observation group,but there was no significant difference compared with that in control group(P ＞ 0.05).Conclusion Triofiban on the basis of aspirin and clopidogrel in the treatment of senile NSTEACS is effective and safe.