老年双联抗血小板治疗患者上消化道出血的危险因素分析

Risk factors analysis of upper gastrointestinal bleeding in elderly patients with aspirin and clopidogrel co-therapy

目的 探讨双联抗血小板治疗的老年冠心病患者上消化道出血的发生情况及可能的预防措施.方法 收集长期就诊及随诊的758例经双联抗血小板治疗老年冠心病患者的临床资料,包括既往病史、入选时的一般状况、临床用药情况、生化指标及临床转归,观察终点包括发生上消化道出血、死亡、停止应用双联抗血小板药物10 d以上,随诊时间6个月.结果 共有48例患者发生上消化道出血,发生率6.3%（48/758）.联合应用质子泵抑制剂（PPI）、H2受体拮抗剂（H2RA）、L谷氨酰胺呱仑酸钠颗粒（麦滋林）＋PPI、麦滋林＋H2RA及单纯应用双联抗血小板药物患者上消化道出血发生率分别为3.7%（4/108）、5.0%（12/240）、1.4%（1/70）、2.9%（3/102）、11.8%（28/238）,5种治疗方法上消化道出血发生率比较差异有统计学意义（x2=18.63,P=0.001）.结论 双联抗血小板药物随访6个月上消化道出血的发生率较高,联合应用麦滋林类胃黏膜保护剂与PPI可最大限度地减少上消化道出血的发生.

Objective To explore the current occurrence of upper gastrointestinal bleeding （UGIB）in elderly patients and its possible risk factors and treatment program. Methods The clinical data of 758 elderly coronary heart disease patients with aspirin and clopidogrel co-therapy were collected, including past medical history,common condition,clinical medication,biochemical indicator and clinical turnover. The follow-up ended on the dates of a first occurrence of UGIB and death or after stopping co-therapy above 10 days. The follow-up time was 6 months. Results UGIB occurred in 48 patients,the occurrence rate was 6.3% （48/758）. The occurrence rate of UGIB in proton pump inhibitor （PPI）, H2-receptor antagonist （H2RA）, gastric mucosa protective agents plus PPI, gastric mucosa protective agents plus H2RA and control was 3.7% （4/108）,5.0% （12/240）,1.4% （1/70）,2.9% （3/102）,11.8% （28/238）. There were statistic differences in different methods （x2 = 18.63,P = 0.001）. Conclusions The occurrence rate of UGIB combined with aspirin and clopidogrel co-therapy in elderly is high. Co-prescription with PPI and gastric mucosa protective agents is associated with a lower risk.