经皮冠状动脉介入治疗1年内上消化道出血分析

Incidence and predictors of upper gastrointestinal haemorrhage post percutaneous coronary interventions within one year

目的:探讨冠心病患者经皮冠状动脉介入治疗(PCI)后1年内,引起上消化道出血(UGH)的主要危险因素。方法:选择行PCI的冠心病患者432例,分析比较1年内发生UGH和未发生UGH患者的临床资料的差异。结果:本组UGH发生率为5.3%(23/432),其中,高龄、急性心肌梗死、既往有消化性溃疡病史、合并慢性支气管炎的患者UGH发生率较高,分别为6.7%、11.5%、9.6%和9.8%,与相应患者比较差异有统计学意义(P<0.05)。术中应用血小板GPⅡb/Ⅲa受体拮抗剂的患者UGH发生率(12.5%)高于未应用血小板GPⅡb/Ⅲa受体拮抗剂的患者(2.7%),差异有统计学意义(P<0.01)。围术期使用和术后1年内间断使用质子泵抑制剂的患者UGH发生率(2.2%)与未使用的患者(13.7%)比较,差异有统计学意义(P<0.05)。结论:高龄、急性心肌梗死、既往有消化性溃疡病史、合并慢性支气管炎增加PCI后UGH的发生,术中应用Ⅱb/Ⅲa受体拮抗剂进一步增加UGH,制酸药物质子泵抑制剂可减小UGH的风险。

Objective：To observe the incidence and the predictors of upper gastrointestinal haemorrhage（UGH） in patients underwent percutaneous coronary interventions（PCI） within one year.Method：From April 2005 to April 2008,a total of 432 patients underwent PCI in our hospital were recruited.The clinical characteristics were analyzed for comparing the differences between UGH and no-UGH patients during one year after procedure.Result：UGH occurred in 23 out of 432 PCI patients（5.3%）,and the incidence of UGH was significantly higher in patients aged more than 75 years（6.7%）,admission with acute myocardial infarction（11.5%）,peptic ulcer history（9.6%）,chronic bronchitis（9.8%） than patients without above factors.There were significant differences（P0.05）.Low molecular weight heparin and platelet glucoprotein Ⅱb/Ⅲa receptor antagonist use during the procedure contributed to the development of UGH,so a higher incidence of UGH was found in these patients than those ones not given above drugs（12.5% versus 2.7%,P0.01）.The incidence of UGH in patients given proton pump inhibitors during peri-operative period and within one year after the operation,and in patients not given these drugs was 2.2% and 13.7% respectively,and there was a significant difference（P0.05）.Conclusion：Age more than 75 years,admission with acute myocardial infarction,peptic ulcer history,chronic bronchitis were closely related to the development of UGH post PCI,and also platelet glucoprotein Ⅱb/Ⅲa receptor antagonist use during the procedure contributed to it.The use of proton pump inhibitors could reduce the risk of UGH in patients underwent PCI during our observations.