2种质子泵抑制剂预防冠脉支架术后消化道出血的最小成本分析

Analysis of the Cost-minimization of 2 Kinds of Proton Pump Inhibitors in the Prevention of Patients with Gastrointestinal Bleeding after Coronary Stenting

目的：评价两种质子泵抑制剂预防冠脉支架术后消化道出血的经济学效果。方法：收集2013年3月-2014年2月某院心血管内科急性冠脉综合征支架术后患者141例,按所选质子泵抑制剂不同分为泮托拉唑组（71例）和雷贝拉唑组（70例）。两组在常规治疗基础上分别使用泮托拉唑（40 mg/d,po,qd）和雷贝拉唑（20 mg/d,po,qd）,疗程为4~5 d。观察两种治疗方案开始用药后2周内预防患者消化道出血的疗效,以及用药后6个月的心血管不良事件,并进行最小成本分析。结果：泮托拉唑组和雷贝拉唑组的有效率分别为94.37%、92.86%,组间比较差异无统计学意义（P〉0.05）;血管不良事件发生率比较差异无统计学意义（P〉0.05）。两组成本分别为1 537.1、1 859.3元,泮托拉唑组的成本较低。结论：泮托拉唑与雷贝拉唑均可有效预防冠脉支架术后患者的消化道出血事件,但使用泮托拉唑的经济性更好。

OBJECTIVE： To evaluate the cost-effectiveness of 2 kinds of proton pump inhibitors （PPI） in the prevention of pa- tients with gastrointestinal bleeding after coronary stenting. METHODS： 141 patients with stenting in acute coronary syndrome in the cardiology department of a hospital from Mar. 2013 to Feb. 2014 were collected and divided into pantoprazole group （71 cases） and rabeprazole group （70 cases） by the PPI. Based on the routine treatment, the 2 groups were respectively given pantoprazole （40 mg/d, po, qd） and rabeprazole （20 mg/d, po, qd） as the PPI. The course was about 4-5 days. The clinic data was observed, including the efficacy of 2 regimens in the prevention of gastrointestinal bleeding within 2 weeks and the cardiovascular adverse re- actions （ADR） after 6 months. Cost-minimization analysis was performed. RESULTS： The effective rate of pantoprazole group and rabeprazole group was respectively 94.37% and 92.86%, with no significant difference （P〉0.05） ; there was no significant differ- ence in the incidence of vascular ADR （P〉0.05）. The cost in 2 groups was respectively 1 537.1 and 1 859.3 yuan and pantopra- zole group had lower cost. CONCLUSIONS： Both pantoprazole and rabeprazole can effectively prevent the gastrointestinal bleeding of patients after coronary stenting. However, pantoprazole has better economics.