使用Ticlopidine於接受冠狀動脈繞道手術後患者之臨床結果

The Use of Ticlopidine to Prevent the Occlusion of the Implanted Grafts After Coronary Artery Bypass Surgery

張珩(Hang Chang) ； 王世名(Shih-Ming Wang) ； 吳鋼治(Gong-Jhe Wu) ； 錢本文(Poom-Unz Chienz) ； 秦意惠(Yih-Huey Chyn) ； 周財福(Tsai-Fwu Chou) ； 朱樹勳(Shu-Hsun Chu) ； 洪啟仁(Chi-Ren Hung)

《慈濟醫學雜誌》 3卷4期 (1991/12) Pp. 289-299

https://doi.org/10.6440/TZUCMJ.199112.0289

摘要

在一九九○年二月迄一九九○年十二月間，吾人對44位接受狀動脈繞道手術(coronary artery bypass graft surgery)患者進行研究。研究的主要目的在探討抗血小板藥物－Ticlopidine使用於冠狀動脈繞道手術後之效果。評估的項目包括：(1)替代植入物（implanted graft）之暢通率；(2)手術後殘存失血（residual ischemia）之發生率；(3)手術後心肌梗塞發生率；(4)心室功能之狀況；(5)副作用發生情形與相關機率。為了得到更客觀的比較結果，我們將受研究患者分成二組以進行比較分析。第一組患者有22人，每天服用Ticlopidine 300mg；第二組患者22人，每天服用Aspirin 100mg及Dipyridamole 150mg。研究的結果發現(1)每日服用Ticlopidine 300mg確可抑制血小板凝集反應，促進冠狀動脈及冠狀動脈繞道植入物之暢通，減少手術後早期心肌失血與心肌梗塞的再發；(2)藉由Ticlopidine抑制血小板生長因素（platelet growth factor）以減緩冠狀動脈及其替代物（graft）之粥狀硬化過程（atherosclerosis）進而促進冠狀動脈及其繞道物之長期暢通（long-term patency）則有待進一步研究與探討；(3)Ticlopidine 300mg於臨床上所發生的副作用極為輕微。
由於上述之結果，我們認為使用Ticlopidine於冠狀動脈硬化疾病患者，不論是預防心肌失血或心肌梗塞的再發，或是提升心肌灌注以強化心臟的功能均有必然的價值。尤其是那些對Aspirin不宜的患者，Ticlopidine確可提供另一條治療的途徑。

關鍵字

Ticlopidine ； 狀動脈繞道手術

並列摘要

From February to December of 1990, 22 patients undergoing cardiopulmonary bypass surgery received Ticlopidine to prevent the occurrence of occlusion of the grafted coronary vessels. In order to generally evaluate the pharmacological effect of Ticlopidine, the patency rate of the implanted grafts was documented, the occurrence of postoperative residual ischemia and myocardial infarction were recorded, the performance of the left ventricle was assessed, and the side effect of Ticlopidine was described. Similar data related to another 22 patients undergoing cardiopulmonary bypass surgery who received Aspirin and Dipyridamole were collected to compare with the Ticlopidine group mentioned above.
The results in our study revealed that (1) Ticlopidine can inhibit platelet aggregation, improve the patency of the graft, thus prevent the occurrence of postoperative myocardial ischemia and related infarction: (2)Because the time duration of this study was limited to 6 months, we do not know the effect of Ticlopidine to the long-term patency rate of the implanted grafts: (3) the side effect of Ticlopidine in clinical use was less than those with Aspirin and Dipyridamole.
We do recommend the use of Ticlopidine to prevent the occlusion of the implanted grafts after coronary artery bypass surgery, especially in the condition that aspirin and Dipyridamole are contraindicated.

並列關鍵字

Ticlopidine ； coronary artery bypass graft