氯吡格雷联合质子泵抑制剂对冠状动脉内支架置入术后的影响分析

Retrospective analysis of the influence of clopidogrel combined with proton pump inhibitor on the prognosis of percutaneous coronary intervention

目的 观察氯吡格雷联合质子泵抑制剂对冠状动脉内支架置入术后的影响. 方法 回顾性分析我院行冠状动脉内支架植入术且术后长期服用氯吡格雷的患者600例,根据是否服用质子泵抑制剂（PPI）制剂分为观察组（300例）和对照组（300例）,比较分析两组支架再狭窄（ISR）以及随诊期间的不良事件发生率. 结果 观察组患者消化道出血的发生率（6.7％）低于对照组（13.7％）（x2 =8.048,P=0.005）,但支架内再狭窄、支架内再次血运重建以及非致死性心肌梗死发生率较对照组升高（x2 =6.426、5.511、4.718,P=0.011、0.019、0.030）. 结论 氯吡格雷与PPI制剂联用可以降低消化道出血的风险,但同时增加了心血管不良事件的发生率,对于需要长期服用PPI制剂的患者,建议谨慎使用.

Objective To observe the influence of clopidogrel combined with proton pump inhibitor （PPI） on the postoperative complication of percutaneous coronary intervention.Methods The clinical data of 600 patients who were taking clopidogrel antiplatelet therapy were retrospectively analyzed.All patients were divided into observation group （with PPI,n =300） and control group （without PPI,n=300）.In-stent restenosis （ISR） and the adverse event rates were compared between the two groups during the period of follow up.Results The incidence of gastrointestinal bleeding was less in observation group than in control group （6.7% vs.13.7%,x2 =8.048,P〈0.01）,but the incidences of ISR,target vessel revascularization （TVR） and non-fatal myocardial infarction were higher in observation group than in control group（x2 =6.426、5.511、4.718,all P〈0.05）.Conclusions Clopidogrel combined with PPI treatment can significantly reduce the risk of gastrointestinal bleeding,but increase the incidences of major adverse cardiovascular events.We suggest that PPI should be used with caution for the patients who need longer-term PPI use.