既往脑出血患者经皮冠状动脉介入治疗术后双重抗血小板治疗早期安全性和有效性研究

发布时间：2018-04-08 17:10

本文选题：脑出血　切入点：血管成形术　出处：《中国全科医学》2017年22期

【摘要】：目的探讨既往脑出血患者经皮冠状动脉介入治疗(PCI)术后双重抗血小板治疗(双抗)住院期间安全性及有效性。方法收集2013年1月—2014年12月在首都医科大学附属北京安贞医院住院并行PCI术的患者19 233例。选取其中有脑出血病史患者25例作为观察组;按照1∶2比例选取同期住院年龄、性别、相关危险因素匹配的无脑出血病史的患者50例作为对照组。所有入选病例均在PCI术前开始服用阿司匹林100 mg,1次/d+氯吡格雷75mg,1次/d至出院。统计比较两组一般资料、住院期间双抗安全性(包括院内脑出血和主要出血、缺血性心脑血管病、任何原因导致死亡)及有效性(包括患者住院情况及PCI术情况),并分析其可能的机制。结果两组男性比例、年龄、高血压病史、糖尿病病史、高脂血症病史、冠心病病史、降压药物使用率、抗血小板药物使用率、降糖药物使用率、收缩压、舒张压、脉搏、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白比较,差异无统计学意义(P0.05);两组患者缺血性卒中/短暂性脑缺血发作(TIA)史、他汀类药物使用率、低密度脂蛋白比较,差异有统计学意义(P0.05)。两组均未发生院内脑出血及主要出血,均未出现院内新发缺血性心脑血管病,观察组发生心源性死亡1例,对照组无死亡。两组住院时间、PCI术前双抗时间、急性心肌梗死发生率、抗凝药物使用率比较,差异有统计学意义(P0.05);两组患者降糖药物、降压药物使用率比较,差异无统计学意义(P0.05)。两组支架数分布、二次手术率比较,差异有统计学意义(P0.05)。结论既往脑出血患者PCI术后双抗治疗住院期间并未增加脑出血及主要出血的风险,但住院期间死亡率有增加趋势;既往脑出血患者合并缺血性脑血管病的发生率更高,住院时间延长,冠心病病情较重,植入多个支架及院内二次手术的比例较高,但PCI术前使用双抗的时间短,既往他汀类药物及院内抗凝药物使用率低,需在PCI过程中加以注意。
[Abstract]:Objective to investigate the safety and efficacy of dual antiplatelet therapy (double antiplatelet therapy) after percutaneous coronary intervention (PCI) in patients with cerebral hemorrhage.Methods from January 2013 to December 2014, 19 233 patients underwent PCI surgery in Beijing Anzhen Hospital affiliated to Capital Medical University.All patients were treated with aspirin 100 mg / d before PCI, 75 mg / d clopidogrel per day and discharged from the hospital.The general data of the two groups were compared statistically. The safety of double antibodies during hospitalization (including nosocomial intracerebral hemorrhage and major hemorrhage, ischemic cardio-cerebrovascular disease) was compared.Any cause of death) and effectiveness (including patient hospitalization and PCI procedure) and analysis of its possible mechanisms.Results the male ratio, age, history of hypertension, history of diabetes, history of hyperlipidemia, history of coronary heart disease, utilization rate of antihypertensive drugs, utilization rate of antiplatelet drugs, utilization rate of hypoglycemic drugs, systolic blood pressure, diastolic blood pressure, pulse,There was no significant difference in fasting blood glucose, total cholesterol, triacylglycerol and high density lipoprotein between the two groups; the history of ischemic stroke / transient ischemic attack (TIA), the use of statins, and the comparison of low density lipoprotein (LDL) between the two groups.The difference was statistically significant (P 0.05).No nosocomial intracerebral hemorrhage or major hemorrhage was found in both groups, and no new ischemic cardio-cerebrovascular disease occurred in the hospital. One case of cardiogenic death occurred in the observation group and no death occurred in the control group.There were significant differences in the number of stents and the rate of secondary operation between the two groups (P 0.05).Conclusion the risk of intracerebral hemorrhage and major hemorrhage was not increased during the hospitalization of patients with previous cerebral hemorrhage after PCI, but the mortality rate increased during hospitalization, and the incidence of ischemic cerebrovascular disease was higher in patients with previous cerebral hemorrhage.
【作者单位】：首都医科大学附属北京安贞医院全科医疗科;首都医科大学附属北京安贞医院神经内科;
【分类号】：R743.34

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