小剂量阿司匹林肠溶片致上消化道出血危险因素分析

A analysis of the risk factors of upper gastrointestinal bleeding induced by ASA in low dosage

目的观察患者近期服用阿司匹林肠溶片(ASA)后致上消化道出血的危险因素。方法选择服用ASA在服药2月内出现呕血、黑便或大便隐血阳性的患者38例;对照组为30例服用相同制剂无消化道出血征象患者,比较两组患者血液流变学变化、药物致消化不良症状发生率、既往消化性溃疡病史及幽门螺杆菌(H.P)阳性率等指标。结果①出血组出血前PLT(25.4±6.8)×109/L、Fg(3.86±1.2)g/L、PT(10.2±1.6)s、APTT(28.5±5.9)s与对照组PLT、Fg、PT、APTT比较无统计学差异(P>0.05);②出血组出现ASA相关性消化不良症状,包括恶心、呕吐与对照组相比较发生率无统计学差异(P>0.05);③出血组年龄(66.3±8.7)岁较对照组(57.4±6.9)岁高(P<0.05)、出血组既往有消化性溃疡或出血发生率(26.3%)较对照组(5.7%)高(P<0.05)、出血组H.P阳性率(81.6%)较对照组(37.1%)高(P<0.05);④出血组中经胃镜检查发现以糜烂性胃炎者比例最多(44.7%)。结论老年人、既往有消化性溃疡史、H.P阳性者服用小剂量肠溶ASA有较高的上消化道出血风险,应加强伍用胃黏膜保护剂或抑酸剂及根除H.P治疗。

Objective To observe the risk factors of gastrointestinal bleeding induced by patients taking ASA in short time, Methods 38 cases taking ASA in 2 months were selected as bleeding group and they all had different degrees of symptoms including hematemesis, melena or positive occult blood of stool;30 cases taking the same drug without the sign of gastrointestinal bleeding were recouited as control group. The indexes were compared,including the change of hemodynamics,the occur rates of ASA related dyspepsia symptoms, peptic ulcer or bleeding history and positive rates of H. P in two groups. Results ①The indexes of PLT,Fg,PT,APTT were no significant different before and after bleeding in bleeding group, neither to compare those in control group. ②The ASA related symptoms in bleeding group were not significant to those in control group. ③The patients＇ age,peptic ulcer or bleeding history and positive rates of H. P in bleeding group were significant higher than those in control group. ④The proportions of erosive gastitis determined by gastrointenstinal endoscopy were most in bleeding group. Conclusions There are high gastrointestinal bleeding risk in eldly,patients with peptic ulcer or bleeding history and positive H. P only taking low doses ASA. It should take the drugs of endogastric-protect or acid-inhibition and eradicate H. P at the same time as taking ASA to reduce the occur rates of gastrointestinal bleeding.