摘要:目的:探讨氯吡格雷治疗稳定型冠心病的临床疗效。方法:选取2014年1月—2015年1月收治的稳定型冠心病患者180例,按随机数字表法分为2组各90例,2组患者均常规给予调脂、降压、控制血糖及抗心肌缺血等药物治疗。观察组患者在常规治疗基础上给予氯吡格雷治疗,对照组患者在常规治疗基础上给予阿司匹林治疗。随访30 d,比较2组患者血小板聚集率( platelet aggregation rate, PAR)改变情况、心绞痛发作时间、心电图ST段改善情况以及不良反应发生情况。结果:观察组患者PAR由治疗前的(63.7±10.2)%降低为治疗后的(42.3±9.1)%,对照组由治疗前的(62.8±9.4)%降低为治疗后的(49.4±10.2)%,均较同组治疗前明显降低,且观察组降低幅度大于对照组,差异有统计学意义(P<0.05)。观察组患者病情恶化3例(3.7%),对照组10例(10.1%),2组的差异有统计学意义(P<0.05);观察组患者的总有效率为96.7%,高于对照组的71.1%,差异有统计学意义(P<0.05);观察组患者心绞痛发作平均时间为(1.3±1.1) d,低于对照组的(2.4±1.2) d,2组的差异有统计学意义(P<0.05);观察组患者心电图ST段改善总有效率为86.7%,高于对照组的70.0%,2组的差异有统计学意义(P<0.05)。观察组患者出现1例胃肠道不适(1.1%),对照组出现4例(4.5%)牙龈出血及4例消化道出血(4.5%),2组的差异有统计学意义(P<0.05);观察组患者的成本-效果比为1.0,对照组为1.1,2组的差异有统计学意义( P<0.05)。结论:氯吡格雷与阿司匹林对稳定型冠心病患者临床疗效均较好,但氯吡格雷临床疗效及安全性更理想,值得临床推广。%OBJECTIVE:To investigate the clinical efficacy of clopidogrel combined with aspirin in treatment of stable coronary heart disease .METHODS:180 cases with stable coronary artery disease admitted into hospital from Jan .2014 to Jan.2015 were selected to be divided into two groups via the random number table , with 90 cases in each.All patients were given routinely lipid regulation , blood pressure , blood glucose control and anti-ischemic drug therapy .Based on the routine therapy, the observation group received clopidogrel , while the control group received aspirin .After follow-up of 30 d, the changes of platelet aggregation rate (PAR), attack time of angina, improvement of ST in ECG and occurrence of adverse reactions were compared between two group of patients .RESULTS: The PAR in observation group decreased from (63.7 ±10.2)% before treatment to (42.3 ±9.1)% after treatment, as for the control group, it decreased from (62.8 ±9.4)%to (49.4 ±10.2)%, the data were significantly lower than before treatment for the same group , and the decline in observation group was significantly greater than than of control group , with statistically significance (P<0.05). There were 3 cases (3.7%) with the deterioration of diseases in observation group , 10 cases(10.1%) in control group, the difference was statistically significant between two groups ( P<0.05 ) .The total effective rate of observation group were 96.7%, significantly higher than that of control group 71.1%, with statistical significance (P<0.05).The average attack time of angina in observation group were (1.3 ±1.1) d, significantly lower than that in control group (2.4 ±1.2) d, the difference was statistically significant ( P<0.05) .Meanwhile , the total effective rate of improvement of ST in ECG in observation group were 86.7%, higher than that in control group 70.0%, the difference was statistically significant ( P<0.05).And one case (1.1%) with intestinal discomfort in observation group , 4 cases (4.5%) with gingival bleeding and 4 cases of ( 4.5%) with digestive tracthemorrhage in control group , with statistically significant difference ( P<0.05).CONCLUSIONS:The clinical efficacy of clopidogrel and aspirin in treatment of stable coronary heart disease is relatively good , but clopidogrel has a safer clinical effect , which is worthy of worthy of clinical popularization and application .