| 摘要: |
| 目的 采用血栓弹力图（TEG）检测拟行颅内外动脉支架置入术前患者双联抗血小板治疗后血小板抑制情况,寻找术前最佳给药时间、给药剂量,以指导临床。方法 据既往是否有单纯阿司匹林服用史及术前阿司匹林不同给药剂量,将我院93例患者,分为4组,分别为:无服药史低剂量组(阿司匹林100 mg+氯吡格雷75 mg)、无服药史高剂量组(阿司匹林300 mg+氯吡格雷75 mg)、有服药史低剂量组、有服药史高剂量组。TEG检测服药后1 d和服药后3 d花生四烯酸(AA)通路血小板抑制率和二磷酸腺苷(ADP)通路血小板抑制率。结果 不同时间点分析:既往无服药史低剂量组,服药后3 d血小板抑制率\[AA: (89.09±17.42)%, ADP: (57.02±23.97)%\]高于服药后1 d\[AA:(82.24±22.25)%,ADP: (49.62±25.44)%\],差异有统计学意义(P<0.05)；既往无服药史高剂量组,服药后3 d血小板抑制率\[AA: (95.06±8.05)%,ADP: (47.76±24.95)%\]高于服药后1 d\[AA:(88.88±14.66)%,ADP: (36.17±22.71)%\],差异有统计学意义(P<0.05)。不同剂量分析:相同服药时间下,无服药史低剂量组与高剂量组、有服药史低剂量组与高剂量组,AA通路抑制率差异均无统计学意义。结论 对既往未服用过阿司匹林的脑血管病患者,支架置入术前抗血小板治疗3 d比治疗1 d可达到更好的血小板抑制效果,而低剂量与高剂量间血小板抑制效果相当。 |
| 关键词: 脑血管障碍 血管成形术 血小板聚集抑制剂 阿司匹林 氯吡格雷 血栓弹力图 |
| DOI： |
| 投稿时间：2013-03-25修订日期：2013-07-08 |
| 基金项目:上海市市级医院新兴前沿技术联合攻关项目 (SHDC12012103). |
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| Efficacy of different anti-platelet aggregation regimens before percutaneous transluminal angioplasty and stenting |
| YUAN Lin,LIU Jian-min*,HONG Bo,HUANG Qing-hai,ZHANG Yong-wei,XU Yi,ZHAO Wen-yuan |
(Department of Neurosurgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| Objective To use thromboelastograph (TEG) technique for examining the platelet inhibition effect by aspirin and clopidogrel before percutaneous transluminal angioplasty and stenting (PTAS), so as to search for the optimal timing, dosage for clinical practice. Methods The clinical data of 93 patients were divided into 4 groups according to the aspirin history and different doses of aspirin before PTAS; the 4 groups were: non-medication history with aspirin+lower dose aspirin (aspirin 100 mg+clopidogrel 75 mg, Group 1), non-medication history with aspirin+higher dose aspirin(aspirin 300 mg+clopidogrel 75 mg, Group 2), medication history with aspirin+lower dose aspirin(Group 3), and medication history with aspirin+higher dose aspirin(Group 4). The blood samples were collected on day 1, 3 after anti-platelet aggregation drugs; TEG technique was used to detect arachidonic acid (AA)-induced inhibition rate of platelet aggregation and adenosine diphosphate (ADP) receptor-induced inhibition rate of platelet aggregation. Results For different time points: in group 1, the inhibition rates of platelet aggregation of aspirin and clopidogrel were significantly higher on day 3 (AA: \[89.09±17.42\]%, ADP: \[57.02±23.97\]%) as compared with those on day 1 (AA: \[ 82.24±22.25\]%, ADP: \[49.62±25.44\]%; P<0.05); in group 3, the inhibition rates of platelet aggregation were also significantly higher on day 3 (AA: \[95.06±8.05\]%, ADP: \[47.76±24.95\]%) than those on day 1 (AA: \[88.88±14.66\]%, ADP: \[36.17±22.71)%\]%; P<0.05). For different doses: the AA-induced inhibition rates were not significantly different between group 1 and group 2 or between group 3 and group 4 on day 1 and 3. Conclusion Without aspirin history, the inhibitory effect of platelet aggregation of aspirin before PTAS for 3 d is better than that for 1 d, and there is no difference between those of lower and higher doses. |
| Key words: cerebrovascular disorders angioplasty platelet aggregation inhibitors aspirin clopidogrel thromboelastograph |
