奥美拉唑和泮托拉唑预防急性冠脉综合征患者抗血小板治疗致消化道出血355例

Omeprazole or pantoprazole prevent gastrointestinal bleeding caused by antiplatelet therapy in 355 patients with acute coronary syndrome

目的回顾性分析奥美拉唑和泮托拉唑预防急性冠脉综合征患者应用阿司匹林或氯吡格雷治疗所致消化道出血的有效性和安全性。方法 355例急性冠脉综合征患者,初始治疗给予口服氯吡格雷300 mg和阿司匹林300 mg一次;d 2起分为泮托拉唑(40 mg.d-1)+氯吡格雷(75 mg.d-1)组(CP组)120例、奥美拉唑(20 mg.d-1)+氯吡格雷(75 mg.d-1)组(CO组)115例、奥美拉唑(20 mg.d-1)+阿司匹林(100 mg.d-1)组(AO组)120例,po,qd。3组均同时口服枸橼酸铋钾300 mg,tid和阿托伐他汀20 mg,qd。治疗48 wk,观察3组患者心血管一级终点事件和消化道出血事件,及治疗期间肝、肾功能变化。结果 CP组发生一级终点事件12例(10.0%),CO组23例(20.0%),AO组11例(9.2%);CP组与AO组无显著差异(P>0.05),且均显著低于CO组(P<0.05)。CP组消化道出血8例(6.7%),CO组17例(14.8%),AO组18例(15.0%);CO组与AO组无显著差异(P>0.05),且均显著高于CP组(P<0.05)。3组治疗前后肝、肾功能差异无统计学意义。结论奥美拉唑和泮托拉唑均能安全有效地预防急性冠脉综合征患者应用阿司匹林或氯吡格雷治疗所致的消化道出血,泮托拉唑优于奥美拉唑。

AIM To study the efficacy and safety of omeprazole or pantoprazole on preventing hemorrhage of alimentary tract caused by antiplatelet therapy in patients with acute coronary syndrome.METHODS The 355 patients with acute coronary syndrome were divided into clopidogrel plus pantoprazole group（CP group,n = 120）,clopidogrel plus omeprazole group（CO group,n = 115）and aspirin plus omeprazole group（AO group,n = 115）after initial treatment with oral clopidogrel 300 mg and aspirin 300 mg once.The three groups were treated with clopidogrel 75 mg plus pantoprazole 40 mg,clopidogrel 75 mg plus omeprazole 20 mg,or aspirin 100 mg plus omeprazole 20 mg,po,qd,respectively.On the base of routine therapy all patients accepted bismuth potassium citrate 300 mg,po,tid,and atorvastatin 20 mg,po,qd.The liver and renal function and the incidence of gastrointestinal bleedings and cardiovascular events were observed among the three groups.RESULTS The incidence of cardiovascular events in CP group（12 patients,10.0%）and AO group（11 patients,9.2%）was significantly lower than that of CO group（23 patients,20.0%）（P 0.05）.The incidence of gastrointestinal bleeding in CO group（17 patients,14.8%）was significantly higher than that of CP group（8 patients,6.7%）（P 0.05）and was similar with that of AO group（18 patients,15.0%）.There were no statistic differences of liver and renal functions in three groups before and after the treatment（P 0.05）.CONCLUSION Omeprazole and pantoprazole could effectively prevent gastrointestinal bleeding caused by antiplatelet therapy in patients with acute coronary syndrome,and pantoprazole effects much more markedly than omeprazole.