分析心房颤动合并冠心病患者冠脉支架植入术后三联与二联抗凝的疗效及安全性

陆勇良

【摘要】 目的 分析心房顫动合并冠心病患者冠状动脉（冠脉）支架植入术后三联与二联抗凝的疗效及安全性。方法 80例心房颤动合并冠心病冠脉支架植入术后患者， 按照随机数字表法分为对照组和观察组， 各40例。对照组患者实施二联抗凝治疗， 观察组患者实施三联抗凝治疗， 对比分析两组患者实验室指标及心血管不良情况。结果 治疗前， 两组患者C反应蛋白（CRP）、纤维蛋白原（FIB）、血小板（PLT）以及D-二聚体（D-D）水平比较差异无统计学意义（P>0.05）；治疗后， 两组患者的CRP、FIB、PLT以及D-D水平均明显低于治疗前， 且观察组患者CRP、FIB、PLT及D-D水平均低于对照组， 差异有统计学意义（P<0.05）。治疗后， 观察组患者出现心肌梗死1例， 血运重建1例， 缺血性卒中1例， 心血管不良发生率为7.5%， 对照组患者出现心肌梗死3例， 血运重建5例， 缺血性卒中5例， 心血管不良发生率为32.5%；观察组心血管不良发生率低于对照组， 差异有统计学意义（P<0.05）。结论 三联抗凝治疗心房颤动合并冠心病冠脉支架植入术后患者的效果和安全性优于二联抗凝治疗方式， 临床应用价值较高。

【关键词】 心房颤动；冠心病；冠状动脉支架植入术；三联抗凝；二联抗凝

DOI：10.14163/j.cnki.11-5547/r.2017.30.061

Analysis of the efficacy and safety of triple and double anticoagulation after coronary stent implantation in patients with atrial fibrillation and coronary heart disease LU Yong-liang. Guangdong Province Gaozhou City Peoples Hospital， Gaozhou 525200， China

【Abstract】 Objective To analyze the efficacy and safety of triple and double anticoagulation after coronary stent implantation in patients with atrial fibrillation and coronary heart disease. Methods A total of 80 patients with atrial fibrillation and coronary heart disease after coronary stent implantation were divided by random number table method into control group and observation group， with 40 cases in each group. The control group was treated with double anticoagulation， and the observation group was treated with triple anticoagulation. Comparison and analysis were made on laboratory indicators and cardiovascular adverse events between two groups.

Results Before treatment， both groups had no statistically significant difference in C reactive protein （CRP）， fibrinogen （FIB）， platelets （PLT）， and D-dimer （D-D） levels （P>0.05）. After treatment， both groups had obviously lower CRP， FIB， PLT and D-D level than before treatment， and the observation group had lower CRP、FIB、PLT and D-D level than the control group. Their difference was statistically significant（P<0.05）. After treatment， the observation group had 1 case of myocardial infarction， 1 case of revascularization， 1 case of ischemic stroke， with incidence of cardiovascular adverse events as 7.5%. The control group had 3 cases of myocardial infarction，

5 cases of revascularization， 5 cases of ischemic stroke， with incidence of cardiovascular adverse events as 32.5%. The observation group had lower incidence of cardiovascular adverse events than the control group， and the difference was statistically significant （P<0.05）. Conclusion The efficacy and safety of triple anticoagulation therapy in patients with atrial fibrillation combined with coronary artery stent implantation is better than that of two anticoagulant therapy， and the clinical application value is higher.endprint

【Key words】 Atrial fibrillation ； Coronary heart disease； Coronary stent implantation； Triple anticoagulation； Double anticoagulation

心房颤动是一种常见多发性疾病， 主要病因为患者心律出现失常， 尤其在我国当前人口老龄化的社会现状下， 心房颤动成为影响老年人身体健康及生活质量的关键， 加之老年人大多患有不同程度的冠心病， 因此， 心房颤动合并冠心病在临床上越来越常见， 并呈现出逐年上升的趋势[1， 2]。针对心房颤动合并冠心病， 三联抗凝治疗方式的效果较好、安全性较高， 逐渐成为临床中首选治疗方式[3]。本文针对心房颤动合并冠心病患者冠脉支架植入术后三联和二联抗凝的疗效及安全性进行详细分析， 报告如下。

1 资料与方法

1. 1 一般资料 选取本院2013年1月～2016年1月收治的80例心房颤动合并冠心病并且行支架植入术治疗患者， 按照随机数字表法将患者分为对照组和观察组， 每组40例。对照……