泮托拉唑和吉法酯治疗双联抗血小板所致上消化道出血的对比研究

发布时间：2018-09-06 17:49

【摘要】：目的探讨质子泵抑制剂(proton pump inhibitor,PPI)泮托拉唑和胃黏膜保护剂吉法酯对经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后服用双联抗血小板药物患者上消化道出血的预防效果。方法 1263例PCI术后服用肠溶阿司匹林合并氯吡格雷纳入本研究,按治疗小组分为4组:常规治疗组(n=332)、PPI组(n=318)、胃黏膜保护剂组(n=299)、PPI+胃黏膜保护剂组(n=314)。随访6个月,观察患者的消化道症状、上消化道出血、主要心脏不良事件(major adverse cardiac events,MACE)、不良反应等。结果 52例6个月内发生上消化道出血,其中常规治疗组21例,PPI组9例,胃黏膜保护剂组15例,PPI+胃黏膜保护剂组7例,4组6个月内上消化道出血发生率有统计学差异(χ~2=8.883,P=0.031),其中常规治疗组显著高于PPI组和PPI+胃黏膜保护剂组(P0.05),其他各组间消化道出血发生率无统计学差异(P0.05)。术后3个月内发生上消化道出血34例,占全部上消化道出血65.4%(34/52),4组消化道出血的发生时间无统计学差异(χ2=4.212,P=0.648)。结论泮托拉唑或泮托拉唑联合吉法酯口服可降低PCI术后双联抗血小板药物患者上消化道出血的发生率。上消化道出血的预防性治疗应从PCI术后第1天开始,至少维持3~6个月,甚至更长。
[Abstract]:Objective to investigate the effect of proton pump inhibitor (proton pump inhibitor,PPI) pam Tora and gastric mucosal protectant gifamate on upper gastrointestinal bleeding after percutaneous coronary intervention (percutaneous coronary intervention,PCI) with dual antiplatelet drugs. Methods 1263 patients with enteric aspirin combined with clopidogrel after PCI were divided into 4 groups: routine treatment group (n = 3 3), gastric mucosal protectant group (n = 299) and gastric mucosal protectant group (n = 314). The patients were followed up for 6 months. The symptoms of digestive tract, upper gastrointestinal hemorrhage, major cardiac adverse events (major adverse cardiac events,MACE) and adverse reactions were observed. Results 52 cases had upper gastrointestinal bleeding within 6 months, including 21 cases in routine treatment group and 9 cases in PPI group. There was statistical difference in the incidence of upper digestive tract hemorrhage in 7 cases of PPI gastric mucosal protectant group and 7 cases of PPI gastric mucosal protectant group within 6 months (蠂 ~ 2 + 8.883 P ~ (0.031). The rate of upper digestive tract hemorrhage in routine treatment group was significantly higher than that in PPI group and PPI gastric mucosal protectant group (P0.05), and the other groups were significantly higher than those in other groups (P < 0.05). There was no statistical difference in the incidence of tracheal hemorrhage (P0.05). 34 cases of upper gastrointestinal bleeding occurred within 3 months after operation, accounting for 65.4% (34 / 52) of all upper gastrointestinal bleeding. There was no significant difference in the occurrence time of gastrointestinal hemorrhage among 4 groups (蠂 ~ 2 ~ (2) = 4.212) (P ~ (0.648). Conclusion Pam Tora or pam Tora zoll combined with chifamate can reduce the incidence of upper gastrointestinal hemorrhage in patients with dual antiplatelet drugs after PCI. Prophylactic treatment for upper gastrointestinal bleeding should be maintained at least 3 ~ 6 months or longer from the first day after PCI.
【作者单位】：首都医科大学附属北京安贞医院消化内科;
【分类号】：R573.2

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