应用血栓弹力图评测PCI术后抗血小板药物的临床应用

应用血栓弹力图评测PCI术后抗血小板药物的临床应用

摘要】目的探讨经皮冠状动脉介入治疗(PCI)患者术后，应用血栓弹力图(TEG)监测的血小板抑制率，合理选择应用二联抗血小板药物或三联抗血小板药物。方法经本院收治的冠脉支架植入术患者300例，术后均为常规方法给予抗血小板药物治疗，应用美国Hamoscope公司的TEG分析仪测定ADP途径诱导的血小板抑制率，患者分为抑制率达标及抑制率未达标，选取未达标患者60随机分为2组，Ⅰ组为硫酸氢氯吡格雷(波利维)+阿司匹林，加用西洛他唑(即三联抗血小板组)；另1组为硫酸氢氯吡格雷(波利维)+阿司匹林(二联抗血小板组)。2组患者均随访3个月，记录随访期间不良缺血事件的发生情况。结果二联组与三联组两组间患者PCI术后第3天血小板ADP抑制率差异无统计学意义，二联组

(10.8±3.3)％，三联组(11.4±3.9)％；术后1个月复查血小板ADP抑制率，二联组(10.2±6.6)％，三联组(55.7±16.8)%，两组间差异存在明显差异(P<0.05)，具有统计学意义。结论血栓弹力图(TEG)测定的血小板抑制率，对冠脉支架植入术后患者选择抗血小板药物治疗具有一定的临床价值。

【关键词】血栓弹力图血小板抑制率经皮冠状动脉介入治疗(PCI)

Clinical application of assessing triple antipiatelet therapies after percutaneous coronary intervention by thrombelastography

Liuliu Feng,Yuya Yang,Yanyan Bai,Tianhua Liu,Xinbing Liu,Hongman

Huang,Mingcheng Zhou,Qitan Xu

Department of cardiologic medicine in Shanghai East city hospital, Shanghai 200438

【Abstract】 Objective: To explore the objective status of platelet inhibition ratio determined by thrombelastoglapby(TEG) in patients who have undergone percutaneous coronary intervention(PCI), in order to reasonably choose dual antiplatelet drugs or triple antiplatelet drugs.Methods: 300 patients who have undergone coronary stent implantation in our hospital were all treated with antiplatelet drugs in conventional methods. ADP induced platelet inhibition ratio should be detected by TEG (USA, Hamoscope). On the basis of the results，all the patients were divided to meet standard group and substandard group. 60 patients of the substandard group was choosed randomly and divided into two groups: groupI of aspirin and clopidngrel combined witll cilostazol (triple antiplatelet drugs group) and groupII of aspirin and clopidogrel (dual antiplatelet drugs group). Both groups were received 3-month clinical follow-up visit to definite adverse ischemia events. Results: Three days after PCI, the incidence rates of ischcmia events of dual antiplatelet drugs group and triple antiplatelet drugs group respectively are (10.8±3.3)％ and

(11.4±3.9)％, which is of no statistical significance. One month after PCI, the incidence rates of ischcmia events of dual antiplatelet drugs group and triple antiplatelet drugs group respectively are (10.2±6.6)％ and (55.7±16.8)%. The two groups exist significant difference (P<0.05) and are of significantly statistical difference. Conclusion: Platelet inhibition ratio determined by TEG is of clinical value for the selection of treatment prescription of antipaltelet drugs for PCI patients．

【Key words】 thrombelastoglapby(TEG) platelet inhibition ratio percutaneous coronary intervention(PCI)

联合应用阿司匹林和氯吡格雷抗血小板治疗已经成为经皮冠状动脉介入治疗(PCI)患者的常规治疗方案。近年来，PCI术后患者临床缺血事件发生可能与抗血