本文選題：冠心病PCI術(shù)后 + 吸煙��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究背景:吸煙是公認(rèn)的冠心病的危險(xiǎn)因素,然而,國(guó)外很多研究表明,吸煙者比非吸煙者更能顯著地從氯吡格雷中獲益。這一有悖于常識(shí)的結(jié)論受到人們廣泛關(guān)注,但至今仍無(wú)定論。目的:通過(guò)檢測(cè)吸煙組、非吸煙組患者應(yīng)用氯吡格雷后血小板的抑制率,隨訪主要不良心血管事件(major adverse cardiovascular events,MACE)、出血情況,探討吸煙對(duì)氯吡格雷抗血小板聚集作用及安全性的影響。方法:采用回顧性研究方法,分析2016年1月至10月在火箭軍總醫(yī)院接受經(jīng)皮冠狀動(dòng)脈介入治療(percutaneous coronary intervention,PCI)且術(shù)后應(yīng)用血栓彈力圖(thrombelastography,TEG)監(jiān)測(cè)抗血小板療效的患者151例。依據(jù)是否吸煙分為兩組:吸煙組(n=72)和非吸煙組(n=79)。檢測(cè)術(shù)后3天及1月的血栓彈力圖結(jié)果,記錄氯吡格雷的血小板抑制率數(shù)據(jù)。隨訪住院期間及術(shù)后6個(gè)月內(nèi)的MACE及出血事件。收集的數(shù)據(jù)采用SPSS 20.0軟件進(jìn)行分析。結(jié)果:兩組患者的臨床基線情況比較差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。PCI術(shù)后3天,應(yīng)用TEG檢測(cè)血小板抑制率。血小板抑制率(ADP%),吸煙組為80.94±22.57,非吸煙組為66.65±26.25,吸煙組高于非吸煙組,兩組間差異有統(tǒng)計(jì)學(xué)意義(p=0.01)。血小板抑制率(AA%),吸煙組為83.83±23.65,非吸煙組為82.97±18.93,兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(p=0.81)。術(shù)后1個(gè)月復(fù)測(cè)血栓彈力圖,血小板抑制率(ADP%),吸煙組為81.64±20.37,非吸煙組為69.15±22.89,吸煙組仍高于非吸煙組,兩組間差異有統(tǒng)計(jì)學(xué)意義(p=0.01)。血小板抑制率(AA%),吸煙組為84.01±23.45,非吸煙組為83.18±18.43,兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(p=0.81)。隨訪6個(gè)月內(nèi),兩組間MACE及出血事件,吸煙組MACE發(fā)生7例,出血情況發(fā)生3例,非吸煙組MACE發(fā)生9例,出血事件發(fā)生4例,兩組間MACE及出血事件差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:1.吸煙可以增強(qiáng)氯吡格雷的抗血小板聚集作用2.在隨訪期內(nèi),兩組間MACE及出血事件差異無(wú)統(tǒng)計(jì)學(xué)意義,本研究未能證明吸煙者比非吸煙者更能從氯吡格雷中臨床獲益。
[Abstract]:Background: smoking is a recognized risk factor for coronary heart disease. However, many foreign studies have shown that smokers benefit more from clopidogrel than non-smokers. This conclusion, which runs counter to common sense, has received widespread attention, but it is still inconclusive. Objective: to investigate the effects of smoking on the antiplatelet aggregation and safety of clopidogrel in patients with smoking and non-smoking groups by detecting the inhibition rate of platelet and the bleeding of major adverse cardiovascular events. Methods: a retrospective study was carried out in 151 patients who received percutaneous coronary interventionation from January to October 2016 in Rocket Army General Hospital and monitored the antiplatelet effect by thromboelastography technique. Smoking was divided into two groups: smoking group (n = 72) and non-smoking group (n = 79). Thromboelastogram results were measured 3 days and 1 month after operation, and platelet inhibition rates of clopidogrel were recorded. MACE and bleeding events were followed up during hospitalization and 6 months after operation. The collected data were analyzed by SPSS 20.0 software. Results: there was no significant difference in clinical baseline between the two groups. The platelet inhibition rate was detected by TEG 3 days after PCI. The platelet inhibition rate was 80.94 鹵22.57 in the smoking group and 66.65 鹵26.25 in the non-smoking group, which was higher in the smoking group than in the non-smoking group. The difference between the two groups was statistically significant. The platelet inhibition rate was 83.83 鹵23.65 in smoking group and 82.97 鹵18.93 in non-smoking group. There was no significant difference between the two groups. One month after operation, the thromboelastogram and platelet inhibition rate of ADPI were 81.64 鹵20.37 in the smoking group and 69.15 鹵22.89 in the non-smoking group, which were still higher than those in the non-smoking group. The difference between the two groups was statistically significant. The platelet inhibition rate was 84.01 鹵23.45 in smoking group and 83.18 鹵18.43 in non-smoking group. There was no significant difference between the two groups. Within 6 months of follow-up, there were 7 cases of MACE, 3 cases of bleeding, 9 cases of MACE and 4 cases of hemorrhage in smoking group and non-smoking group. There was no significant difference in MACE and bleeding events between the two groups (p 0.05). Conclusion 1. Smoking enhanced the antiplatelet aggregation of clopidogrel 2. During the follow-up period, there was no significant difference in MACE and bleeding events between the two groups. This study failed to prove that smokers were more likely to benefit from clopidogrel than non-smokers.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R541.4

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本文編號(hào)：1820170