目的评价硫酸氢氯吡格雷在冠状动脉内支架置入术后短期临床应用效果。方法选择2002年3月至2003年7月间因不稳定型心绞痛及急性心肌梗死行冠脉内支架置入术的患者,共103例。所有患者术前及术后服用硫酸氢氯吡格雷75mg/d,共4~6周,观察患者服药期间急性或亚急性血栓形成、心绞痛、再发心肌梗死和死亡等心血管事件及药物的不良反应。结果103例患者中有1例患者术后1周死于心原性休克;1例急性前壁心肌梗死单纯行经皮冠状动脉腔内成形术患者,术后3小时发生冠脉急性闭塞,再次介入治疗并置入支架后症状消失;其余101患者在服药期间无心血管事件发生。4例患者服药期间出现皮疹,停用硫酸氢氯吡格雷维后皮疹消失,2例患者继续服用;服药期间未见粒细胞减少、出血、腹泻等副作用。对存活的102例患者术后随访1~12月,1例患者术后3个月再发心肌梗死;1例患者术后6个月再发心绞痛;其余患者在随访期间无心血管事件发生。结论硫酸氢氯吡格雷在冠脉内支架置入术后短期应用可预防支架术后急性或亚急性血栓形成,并且其副作用少。 Objective To evaluate the short-term clinical effect of clopidogrel bisulfate after coronary stenting. Methods A total of 103 patients undergoing coronary stenting for unstable angina and acute myocardial infarction between March 2002 and July 2003 were enrolled. All patients were treated with clopidogrel hydrogen sulfate 75 mg / d preoperatively and postoperatively for 4 to 6 weeks to observe the cardiovascular events such as acute or subacute thrombosis, angina pectoris, recurrent myocardial infarction and death, and drug dyspepsia reaction. Results One of the 103 patients died of cardiogenic shock one week after operation. One patient with acute anterior myocardial infarction was treated with percutaneous transluminal coronary angioplasty. Acute coronary occlusion occurred 3 hours after the operation. Symptoms disappeared after treatment and stent placement; the remaining 101 patients had no cardiovascular events during their medication. Four patients had a rash during medication, and the rash disappeared after discontinuation of clopidogrel hydrogen sulfate, and two patients continued to take it. No side effects such as neutropenia, bleeding and diarrhea were observed during the medication. 102 survivors were followed up for 1 to 12 months, 1 patient developed myocardial infarction 3 months after surgery, 1 patient developed angina at 6 months after operation, and the rest had no cardiovascular events during follow-up. Conclusion Short-term use of clopidogrel bisulfate after coronary stenting can prevent acute or subacute thrombosis after stenting and has few side effects.