质子泵抑制剂对PCI术后双联抗血小板治疗所致上消化道出血的影响

Influence of proton pump inhibitors on upper gastrointestinal bleeding induced by dual antiplatelet therapy after PCI

目的探讨质子泵抑制剂对PCI术后双联抗血小板治疗所致上消化道出血的影响。方法选择冠状动脉粥样硬化性心脏病并接受PCI治疗的患者218例,随机分为观察组与对照组。观察组在阿司匹林+氯吡格雷抗血小板治疗的基础上联合口服埃索美拉唑治疗,比较2组患者血小板聚集率、上消化道出血和支架内血栓形成的发生率。结果 2组患者PCI术前及术后12周比较血小板聚集率均无显著差异(P>0.05);术后随访12月,观察组无上消化道出血发生,对照组发生率为3.67%,差异有统计学意义(P<0.05);观察组支架内血栓形成2例(1.83%),对照组1例(0.91%),差异无统计学意义(P>0.05)。结论埃索美拉唑可预防患者PCI术后双联抗血小板治疗所致上消化道出血等并发症的发生,且并未影响抗血小板活性,也未增加支架内血栓形成的概率。

Objective To investigate the influence of proton pump inhibitor on upper gastrointestinal bleeding induced by dual antiplatelet therapy after PCI.Methods Two hundred and eighteen PCI-treated patients with coronary atherosclerotic heart disease were randomly divided into observation group and control group.The observation group was treated with dual antiplatelet therapy,aspirin and clopidogrel,combined with oral esomeprazole treatment.The platelet aggregation rate,the incidence of upper gastrointestinal bleeding and stent thrombosis were compared between the two groups.Results Before and 12 weeks after PCI,there were not significant differences in platelet aggregation rate between the two groups （P ＞0.05）.The difference was of statistical significance （P ＜ 0.05）.The incidence of upper gastrointestinal bleeding in the observation group was zero and that in the control group was 3.67％ 12 months after the operation.The stent thrombosis rate in observation group was 1.83 ％ and that of the control group 0.91％,the difference being not statistically significant （P ＞ 0.05）.Conclusion Esomeprazole can prevent upper gastro intestinal bleeding complications in patients after PCI treatment with dual antiplatelet therapy,and does not affect the anti-platelet activity and the incidence of stent thrombosis.