经皮冠状动脉介入治疗后患者住院期间合并上消化道出血分析

Incidence of in-hospital upper gastrointestinal haemorrhage post percutaneous coronary interventions in the drug eluting stent era:a single center experience

目的评价接受 PCI 的患者术后住院期间合并上消化道出血(UGH)的发生率、影响因素及转归。方法选择2002年9月至2006年3月接受 PCI 的2279例冠心病患者,其中21例患者PCI 后发生 UGH,分析所有患者的临床特点及预后,讨论影响 UGH 发生的预测因素。结果年龄≥70岁、女性、合并糖尿病、消化性溃疡病史、以急性冠状动脉综合征入院的患者 UGH 发生率较高;PCI术中应用血小板糖蛋白Ⅱb/Ⅲa受体拈抗剂以及接受急诊 PCI 的患者 UGH 发生率相对较高;发生UGH 的患者住院期间及随访6个月总的主要心脑血管不良事件(死亡、心肌梗死、靶血管重建、脑卒中)发生率显著高于未发生 UGH 的患者(23.0%比9.3%,P<0.01);发生 UGH 的患者平均住院时间明显延长(13.8 d 比5.1 d,P<0.001);年龄≥70岁[比值比(OR)值2.23,95%可信区间(CI)1.01～4.13,P<0.01]、以急性冠状动脉综合征入院(OR 值1.91,95% CI 0.57～2.52,P<0.05)以及消化性溃疡病史(OR 值1.02,95% CI 0.17～2.25,P<0.05)是 PCI 患者术后住院期间发生 UGH 的预测因素。结论接受 PCI 的患者住院期间 UGH 发生率为0.92%,年龄≥70岁、以急性冠状动脉综合征入院及消化性溃疡病史是发生 UGH 的预测因素,合并 UGH 的患者住院及6个月随访主要不良心脑血管事件发生率增加。

Objective To observe the incidence and the predictors of upper gastrointestinal haemorrhage （UGH） in patients underwent percutaneous coronary interventions （PCI）. Methods UGH occurred in 21 out of 2279 PCI patients （0. 92% ）. The clinical characteristics, procedural and prognostic status of all UGH patients were analyzed. Results The incidence of UGH was significantly higher in patients aged more than 70 years, female, diabetes mellitus, peptic ulcer history, admission with ACS than patients without above factors. Platelet glucoprotein Ⅱ b/Ⅲ a receptor antagonist use during the procedure and primary PCI also contributed to the development of UGH. Hospitalization time was significantly longer in patients with UGH compared with patients without UGH （ 13. 8 versus 5. 1 days, P 〈 0. 001 ）. The total MACCEs including myocardial infarction, TVR and death rate in patients with UGH were higher than that in patients without UGH （23.0% versus 9. 3%, P 〈 0. 01 ）. Stepdown multivariate logistic regression analysis revealed that age more than 70 years （ OR 2. 23, 95% CI 1.01-4. 13, P 〈 0.01 ） , admission with acute coronary syndrome （ OR 1.91,95% CI O. 57-2. 52, P 〈0. 05 ） and history of peptic ulcer （ OR 1.02, 95% CI O. 17-2. 25, P 〈 0. 05 ） were the predictors of in-hospital UGH post PCI. Conclusion Age more than 70 years, admission with ACS and peptic ulcer history were closely related to the development of in-hospital UGH post PCI and hospitalization was prolonged in UGH patients.