王源泉+张晓静+邹建华

[摘要]目的 探讨硫酸氢氯吡格雷联合阿司匹林肠溶片对老年冠心病患者凝血指标及血小板聚集率情况的影响。方法 选择80例老年冠心病患者作为观察对象，以随机数字表法将患者分为阿司匹林组及联合组，每组40例，阿司匹林组接受阿司匹林肠溶片抗凝治疗，联合组接受硫酸氢氯吡格雷联合阿司匹林肠溶片抗凝治疗，分析两组治疗过程中凝血指标及血小板聚集率变化情况。结果 两组治疗过程中，PT、APTT及INR呈升高趋势，FIB及PAR呈下降趋势（P<0.05），入组时及治疗7d时比较，两组间PT、APTT、INR、FIB及PAR比较，未见统计学差异（P>0.05），而在治疗14d及治疗28d时，联合组PT、APTT及INR高于阿司匹林组，FIB及PAR低于阿司匹林组（P<0.05）。同时，两组治疗过程中，药物不良反应发生率比较，无统计学差异（P>0.05）。结论 在老年冠心病的治疗中硫酸氢氯吡格雷联合阿司匹林肠溶片可在不增加药物不良反应发生率的同时，有效的改善患者的凝血及血小板聚集率指标。

[关键词] 硫酸氢氯吡格雷；阿司匹林肠溶片；老年；冠心病；凝血指标；血小板聚集率

[中图分类号] R543.3 [文献标识码] A [文章编号] 2095-0616（2017）06-23-04

[Abstract] Objective To explore the effect of clopidogrel bisulfate combined with aspirin on blood coagulation and platelet aggregation in elderly patients with coronary heart disease. Methods 80 elderly patients with coronary heart disease were selected as the observation objects. According to random number table method， they were divided into aspirin group and combination group with 40 cases in each. Patients in aspirin group were treated with aspirin enteric-coated tablets anticoagulant therapy， and patients in combination group were treated with clopidogrel bisulfate combined with aspirin. Changes of coagulation index and platelet aggregation rate during treatment of the two groups were analyzed. Results During the treatment， PT， APTT and INR of the two groups showed an increasing trend， FIB and PAR showed a downward trend（P<0.05）. There was no significant difference in PT， APTT， INR， FIB and PAR between the two groups（P>0.05） when compared on beginning the group and on the 7d after treatment. However， PT， APTT and INR in the combination group were higher than those in the aspirin group in the treatment of 14d and 28d， and the FIB and PAR were lower than those in the aspirin group（P<0.05）. At the same time， there was no significant difference in the incidence of adverse drug reactions between the two groups（P>0.05）. Conclusion Clopidogrel bisulfate combined with aspirin on blood coagulation and platelet aggregation in elderly patients with coronary heart disease can not only increase the incidence of adverse drug reactions， but also improve the coagulation and platelet aggregation rate.

[Key words] Clopidogrel bisulfate； Aspirin enteric-coated tablets； Old age； Coronary heart disease； Coagulation index； Platelet aggregation rate

冠心病是以冠状动脉粥样硬化为病理基础，以胸闷、胸痛及心律失常为主要临床表现的心肌缺血缺氧性疾病[1-2]。本病以老年人为好发人群，患者病發如不及时治疗，极易进一步发展成为急性心肌梗死及心力衰竭，而对患者的生命安全造成严重的影响[3-4]。抗凝治疗为冠心病的基础治疗方案之一，其可通过改善患者的凝血状态而达到改善患者预后的作用，但近年来临床观察显示，不同的抗凝治疗方案，其所达到的抗凝效果间尚存在一定的差异[5-6]。……