质子泵抑制剂防治老年冠状动脉介入术后上消化道出血并发症的疗效观察

Efficacy of proton pump inhibitors in prevention of upper gastrointestinal bleeding complication after PCI in elderly patients

目的评价质子泵抑制剂(PPI)防治老年冠心病患者PCI术后上消化道出血并发症的疗效和安全性。方法接受PCI的老年患者800例,随机分为PPI干预组和对照组,每组400例。2组PCI术前、术后常规双联抗血小板,PPI干预组在PCI术前即服用埃索美拉唑镁40 mg/d,连续4周,随后改为40 mg/2d,直至氯吡格雷停用。随访1 8个月,观察2组患者服药期间上消化道不良反应的发生率;监测血小板聚集率;观察主要心脏不良事件(MACE)。结果 PPI干预组无消化道出血事件发生,仅11例出现轻微消化道症状;对照组79例出现不同程度消化道症状,便隐血强阳性39例,其中7例为严重上消化道出血,2组比较差异有统计学意义(P<0.01)。2组血小扳聚集率和MACE发生率差异无统计学意义(P>0.05)。结论老年患者PCI术后加用PPI可有效防治消化道不良反应,减少上消化道出血并发症发生,且对血小板聚集率无明显影响,未增加心血管事件风险。

Objective To investigate the efficacy and safety of proton pump inhibitors（PPI） in prevention and treatment of upper gastrointestinal（GI） injury and bleeding complications induced by combined administration of clopidogrel and aspirin in patients undergoing percutaneous coronary intervention（PCI）. Methods 800 elderly coronary artery disease patients were randomly divided into 2 groups. Eight patients missed follow up. 397 cases were administrated with PPI and 395 cases were in control group. Before and after PCI procedure, all patients were administered with clopidogrel and aspirin for 12 months. At the end of follow up,the incidence of upper GI side effect and upper GI bleeding events were observed. Ptatelet aggregation was examined at different sta- ges. Major adverse cardiac events（MACE） including mortality,reinfarction and target vessel revascularization were observed during follow-up. Results There was no case of upper GI bleeding event, but there were 11 cases of mild upper GI side effects in PPI group. Seventy-nine patients in control group experienced upper GI side effect symptoms,of them 39 had occult blood（＋＋＋） and 7 experienced upper GI bleeding events, the difference was statistically siguificant （P〈 0.01）. No differences in the platelet aggregation and incidence rate of MACE were observed be- tween the two groups （P 〉 0.05）. Conclusion PPI for the prevention and treatment of upper GI adverse reaction induced by combined therapy with clopidogrel and aspirin in elderly patients undergoing PCI was safe and effective.