双联抗血小板药物联合泮托拉唑治疗缺血性脑卒中的临床研究

The research of double antiplatelet drug combined with pantoprazole in the treatment of ischemic stroke

目的：研究双联抗血小板联合泮托拉唑治疗缺血性脑卒中患者是否能明显减少消化道损伤及是否增加心血管不良事件发生率。方法筛取270例确诊“缺血性脑卒中”患者，随机分为两组，入组病例均连续应用阿司匹林＋氯吡格雷双联抗血小板治疗90 d，联合治疗组为接受泮托拉唑40 mg 口服联合治疗（137例），常规治疗组不接受任何保护胃黏膜药物治疗（133例）。比较两组出现消化道损伤症状及心血管不良事件发生率。结果两组各有1例失访、随访90 d，联合治疗组（136例）出现消化不良症状26例（19．11％）；大便潜血试验阳性11例（8．08％）；排黑便4例（2．94％）；呕血0例。常规治疗组（132例）出现消化不良症状41例（31．06％）；大便 OBT（＋）23例（17．42％）；排黑便19例（14．39％）；呕血4例（3．00％）。两组各指标差异均有统计学意义（χ2＝6．66、4．56、11．20和4．18，均 P ＜0．05）。联合治疗组出现心悸胸闷等症状5例（3．68％）、心电图确诊心肌缺血4例（2．94％），心肌梗死及因心血管病死亡均为0例；常规治疗组出现心悸胸闷等症状4例（3．03％）、心电图确诊心肌缺血3例（2．27％）、心肌梗死及因心血管病死亡均为0例。两组各指标差异均无统计学意义（χ2＝0．086和0．125，均 P ＞0．05）。结论泮托拉唑对减少双联抗血小板治疗的缺血性脑卒中患者继发消化道损害发生率具有积极临床意义；其应用未增加患者心血管不良事件的发生率。

Objective To research whether double antiplatelet drug combined with pantoprazole can reduce digestive tract damage,or aggravate cardiovascular system side effect.Methods 270 patients diagnosed as ischemic stroke received double antiplatelet drug were randomly divided into two groups.The treatment group received pantoprazole,the control group did not took any gastric drug.The side effect of the digestive and cardiovascular system was observed.Results 268 patients were followed up for 90 days,and digestive system side effect of the treatment group （136 cases）included indigestion in 26 cases（19.11%）,stool occult blood（＋）in 11 cases（8.08%）,melena in 8 cases（5.89%）,hematemesis in 0 case,and the control group （132 cases）included indigestion in 42 cases （31.82%）,stool occult blood（＋）in 23 cases（17.42%）,melena in 19 cases（14.39%）,hematemesis in 4 cases. There were significant differences between the two groups（χ2 =6.66,4.56,11.2 and 4.18,all P 〈0.05）.Cardiovascular system side effect of the treatment group included palpitation or chest distress or chest pain in 4 cases （3.68%）,myocardial ischemia diagnosed by electrocardiogram in 4 cases（2.94%）,myocardial infarction and died of cardiovascular disease in 0 case,and the control group included palpitation or chest distress or chest pain in 4 cases （3.00%）,myocardial ischemia diagnosed by electrocardiogram in 3 cases（2.27%）,myocardial infarction and died of cardiovascular disease in 0 case.There were no statistical differences between the two groups（χ2 =6.66 and 4.56, both P 〉0.05 ）.Conclusion Double antiplatelet drug combined with pantoprazole had a positive significance in reducing the digestive tract damage of ischemic stroke patients,and didn＇t increase the incidence of cardiovascular system side effect.