目的 探討不同劑量氯吡格雷聯(lián)合阿魏酸哌嗪分散片治療老年冠心病不穩(wěn)定心絞痛的臨床效果。方法 選取2015年8月—2017年8月在平煤神馬醫(yī)療集團(tuán)總醫(yī)院就診的老年冠心病不穩(wěn)定心絞痛患者120例，按照入院先后順序分為觀察組（n=60）和對照組（n=60），兩組患者均給予口服阿魏酸哌嗪分散片100 mg，3次/d，同時對照組和觀察組患者分別給予氯吡格雷75 mg/d和150 mg/d。比較兩組臨床效果、心絞痛發(fā)作頻率和持續(xù)時間、心功能指標(biāo)及不良反應(yīng)發(fā)生率。結(jié)果 與對照組總有效率76.67%比較，觀察組總有效率91.67%顯著升高（P<0.05）。治療后兩組心絞痛發(fā)作頻率和持續(xù)時間均較治療前顯著減少（P<0.05）；且觀察組心絞痛發(fā)作頻率和持續(xù)時間顯著少于對照組（P<0.05）。治療后兩組心輸出量（CO）、左室射血分?jǐn)?shù)（LVEF）、每搏量（SV）均較治療前顯著升高（P<0.05），左室舒張末內(nèi)徑（LVDD）較治療前顯著降低（P<0.05）；且觀察組心功能指標(biāo)（CO、LVEF、LVDD和SV）變化更為顯著（P<0.05）。兩組不良反應(yīng)發(fā)生率（10.00% vs 8.33%）比較，差異不顯著。結(jié)論 大劑量（150 mg/d）氯吡格雷聯(lián)合阿魏酸哌嗪分散片可有效提高老年冠心病不穩(wěn)定心絞痛的臨床療效，并改善心功能。

Objective To investigate the clinical effect of different doses of clopidogrel combined with piperazine ferulate dispersible tablets on unstable angina pectoris in elderly patients with coronary heart disease.Methods 120 elderly patients with unstable angina pectoris in our hospital from August 2015 to August 2017 were divided into observation group (n=60) and control group (n=60) according to the order of admission. Both groups were given 100 mg piperazine ferulate dispersible tablets orally, three times a day, while the control group was given clopidogrel 75 mg/d. The observation group was given clopidogrel 75 mg/d. Give clopidogrel 150 mg/d. The clinical effects of the two groups were compared.Results Compared with the control group, the total effective rate of the observation group was 91.67% significantly higher (P<0.05). After treatment, the attack frequency and duration of angina pectoris in the two groups were significantly reduced (P<0.05), and the attack frequency and duration of angina pectoris in the observation group were significantly reduced (P<0.05). After treatment, CO, LVEF and SV in both groups were significantly higher than before treatment (P<0.05), and LVDD was significantly lower than before treatment (P<0.05). Moreover, the changes of cardiac function(CO, LVEF, LVDD and SV) in the observation group were more obvious (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (10% vs 8.33%).Conclusion High dose (150 mg/d) clopidogrel combined with piperazine ferulate dispersible tablets can effectively improve the clinical efficacy of unstable angina pectoris in elderly patients with coronary heart disease and improve cardiac function.