埃索美拉唑、法莫替丁和铝碳酸镁预防急性冠脉综合征患者上消化道损伤的效果

The efficacy in prevention of upper gastrointestinal injury in patients of acute coronary syndrome with esomeprazole, famotidine and hydrotalciteThe efficacy in prevention of upper gastrointestinal injury in patients of acute coronary syndrome with esomeprazole, famotidine and hydrotalcite

目的观察埃索美拉唑、法莫替丁和铝碳酸镁预防急性冠脉综合征（ACS）患者上消化道损伤的效果。方法符合人选条件的182例患者，在急性冠脉综合征治疗基础上，随机分为4组：A组，对照组；B组，埃索美拉唑20mg，bid；C组，法莫替丁20mg，bid；D组，铝碳酸镁1000mg，tid。治疗期间通过观察呕血、黑便、上腹不适（或疼痛）和烧心症状，检测粪便隐血试验，胃镜检查，确定消化道损伤发生；同时观察心血管不良事件发生。患者出院后门诊随访3个月。结果A组48例，消化道损伤发生率为31．25％（15／48）；B组43例，消化道损伤发生率6．98％（3／43）；C组46例，消化道损伤发生率10．87％（5／46）；D组45例，消化道损伤发生率13．33％（6／45）。四组消化道损伤发生率经统计学分析，B组与A组比较差异有统计学意义（P=0．004），C组、D组与A组比较差异无统计学意义（P〉0．05）。A组中2例（4．17％）因消化道出血停用阿司匹林，发生支架内血栓事件。结论埃索美拉唑、法莫替丁和铝碳酸镁对ACS患者消化道损伤的发生有预防作用，但以埃索美拉唑效果最好。

Objective To observe the efficacy in the prevention of upper gastrointestinal injury in patients of acute coronary syndrome （ACS） with esomeprazole, famotidine and hydrotalcite. Methods 182 patients of ACS were selected as the subjects. The admitted patients were divided into 4 groups randomly. A group（control）：basic treatment （aspirin＋clopidogrel）. B group： basic treatment with esomeprazole 20 rag. C group： basic treatment with famotidine 20 mg, bid. D group： basic therapy with hydrotalcite 1000 mg, tid. All the patients were followed up after the treatment. The situation of gastrointestinal damage （hematemesis, abdomen unwell, bellyache） was observed 3 month after the treatment. Patients who appear the gastrointestinal damage will be given the gastroscope examine. Results The incidence of gastrointestinal injury was 31.25%（15/48）, 6.98%（3/43）, 10.87%（5/46） and 13.33%（6/45） in group A, B, C and D respectively. There was significant difference between group A and B by the pairwise comparison（P=0.004）. In the 48 cases of the control, 2 cases （4.17%） were found with thrombus in the stents, who stopped aspirin for gastrointestinal hemorrhage. Conclusion The gastrointestinal injury of patients with ACS can be prevented safely and effectively with esomeprazole compare with famotidine and hydrotalcite.