血栓弹力图指导老年择期经皮冠状动脉介入患者抗血小板药物使用的研究

摘要

目的 评价以血栓弹力图(TEG)测定二磷酸腺苷(ADP)介导的血小板聚集率指导老年择期经皮冠状动脉介入(PCI)患者抗血小板药物使用的价值.方法 选取我院2009年1～12月老年择期PCI患者280例,根据随机表选取患者144例入选TEG指导组,依据血小板聚集率调整抗血小板药物使用;其余136例患者入选非TEG指导组,口服常规剂量抗血小板药物.2组均随访观察1年.结果 TEG指导组12个月时ADP介导血小板聚集抑制达标率为74%,非TEG指导组56%,差异有统计学意义(P＜0.05).TEG指导组与非TEG指导组1年内心血管事件发生率分别为4.2%和8.1%,差异有统计学意义(P＜0.05).2组均无大出血和严重出血并发症,轻微出血发生率分别为3.5%(5例)和2.9%(4例),差异无统计学意义(P＞0.05).结论 TEG测定ADP介导血小板聚集率指导抗血小板药物个体化使用,可减少老年择期PCI患者术后1年的心血管事件,而不增加出血并发症.%Objective To evaluate the use of antiplatelet drugs in the eldly patients undergoing selected PCI procedure guided by thrombelastograph. Methods Two hundreds and eighty patients with the sirolmus drug eluting stent were enrolled. 136 of them were enrolled in the none-ADP guided group. The rest 144 cases were included in the ADP guided group and had modified use of antiplatelet drugs according to the ADP platelet aggregation index to obtain the eligible standard. All patients were followed up for 12 months. Results The ADP immediate platelet aggregation index reached 74% in the ADP guided group and 56% in the no-ADP guided group. The major adverse cardiac events in the ADP guided group were less than those in the no-ADP guided group. (ADP guided group vs. no-ADP guided group 4. 2% vs. 8.1% , P = 0. 05 ). All patients had no hemorrhea and severe complication of bleeding (P>0.05). Conclusions The application of antiplatelet drugs according to the ADP platelet aggregation index helps decrease the major adverse cardiac events in the patients undergoing the PCI, without increasing bleeding complications.