75岁以上老年冠心病患者应用不同抗血小板药物临床疗效观察

摘要

目的 观察75岁以上老年冠心病患者应用不同抗血小板药物的临床疗效.方法 选取2010年1月～2013年12月在我院住院治疗的208例75岁以上老年冠心病患者,随机分为5组,阿司匹林组44例、氯吡格雷组42例、双联抗血小板组(双联组)38例、双联抗血小板+质子泵抑制剂组(双联+PPI组)43例和对照组41例.比较用药后各组血小板聚集率、临床疗效及消化道出血事件等指标.结果 与对照组用药前比较,双联组及双联+PPI组用药后花生四烯酸及二磷酸腺苷诱导的血小板聚集率均显著下降(P＜0.05);各组临床总有效率比较,阿司匹林组、氯吡格雷组、双联组及双联+ PPI组均显著优于对照组(88.6％、90.5％、94.7％、93.0％ vs 51.2％),差异有统计学意义(P＜0.05).双联组消化道出血事件发生率高于对照组(26.3％ vs 7.3％,P＜0.05),双联+PPI组消化道出血的发生率显著低于双联组(9.3％ vs 26.3％,P＜0.05).结论 在75岁以上老年冠心病人群中,单独应用一种抗血小板药物是安全有效的.双联抗血小板治疗联合应用质子泵抑制剂能显著降低消化道出血的发生率.%Objective To study the clinical effect of antiplatelet drugs in very old coronary heart disease (CHD) patients.Methods Two hundred and eight very old CHD patients admitted to our hospital from January 2010 to December 2013 were randomly divided into aspirin treatment group (n =44),clopidogrel treatment group (n=42),dual antiplatelet treatment group (n=38),dual antiplatelet plus proton pump inhibitor (PPI) treatment group (n=43) and control group (n=41).Their platelet aggregation rate,clinical effect and gastrointestinal bleeding events were compared after treatment.Results The platelet aggregation rate induced by arachidonic acid and ADP was significantly lower in dual antiplatelet treatment group and dual antiplatelet plus PPI treatment group after treatment than in control group before treatment (P＜0.05).The total effective rate of antiplatelet treatment was significantly higher in 4 treatment groups than in control group (88.6％,90.5％,94.7％,93.0％ vs 51.2％,P＜0.05).The incidence of gastrointestinal bleeding events was significantly higher in dual antiplatelet treatment group than in control group and was significantly lower in dual antiplatelet plus PPI treatment group than in dual antiplatelet treatment group(26.3％ vs7.3％,P＜0.05;9.3％ vs26.3％,P＜0.05).Conclusion Itissafeand effective for very old CHD patients to use any antiplatelet drugs.Dual antiplatelet plus PPI treatment can effectively reduce the incidence of gastrointestinal bleeding events in very old CHD patients.