以埃索美拉唑为基础的治疗方案对氯吡格雷联合阿司匹林长期用药后致上消化道出血患者相关指标的影响

Effects of Esomeprazole-based Regimen on the Related Indicators of Upper Gastrointestinal Bleeding in Patients with Long-term Clopidogrel Combined with Aspirin Treatment

目的:探讨以埃索美拉唑为基础的治疗方案对氯吡格雷联合阿司匹林长期用药后致上消化道出血患者相关指标的影响。方法:96例氯吡格雷联合阿司匹林长期用药后致上消化道出血患者,经快速尿素酶试验后有62例为幽门螺杆菌阳性,34例为幽门螺杆菌阴性(阴性对照组)。按随机数字表法将62例幽门螺杆菌阳性患者分为观察组(31例)和对照组(31例)。阴性对照组和对照组患者在活动性出血期间给予注射用埃索美拉唑钠40 mg,加入0.9%氯化钠注射液100 ml中,静脉滴注,每日2次,同时停用氯吡格雷和阿司匹林;在活动性出血停止3 d后,恢复服用氯吡格雷和阿司匹林,并根据不同的出血原因给予相应的治疗。在此基础上,观察组患者给予埃索美拉唑镁肠溶片20 mg,口服,每日2次+阿莫西林胶囊1.0 g,口服,每日2次+克拉霉素片0.5 g,口服,每日2次,连用2周。在结束治疗后1个月,进行14C呼气试验,根除失败者在治疗结束后的第2个月给予埃索美拉唑镁肠溶片20mg,口服,每日2次+枸橼酸铋钾胶囊0.3g,口服,每日2次+阿莫西林胶囊1.0 g,口服,每日2次+左氧氟沙星片0.5 g,口服,每日1次,连用2周。所有患者在完成治疗后均随访6个月。观察各组患者疼痛缓解时间、消化道症状缓解时间、上消化道再出血发生情况及不良反应发生情况,记录观察组患者的幽门螺杆菌根除情况。结果:观察组患者首次治疗后有22例幽门螺杆菌为阴性,根除率为71.0%,未根除者经第二次治疗后幽门螺杆菌均为阴性,总根除率为100%。观察组患者上消化道再出血总发生率显著低于对照组及阴性对照组,差异均有统计学意义(P<0.05)。各组患者疼痛缓解时间、消化道症状缓解时间、不良反应发生率比较差异均无统计学意义(P>0.05)。结论:以埃索美拉唑为基础的治疗方案,可通过根除幽门螺杆菌来降低氯吡格雷联合阿司匹林长期用药后致上消化道出血患者的上消化道再出血发生率,且安全性较好。

OBJECTIVE： To investigate the effects of esomeprazole-based regimen on the related indicators of upper gastrointesti- nal bleeding in patients with long-term clopodogrel combined with aspirin treatment. METHODS： In the 96 patients long-term clopodo- grel combined with aspirin treatment and upper gastrointestinal bleeding, 62 were helicobacter pylori positive by rapid urease test and the other 34 were helicobacter pylori negative （negative control group）. The 62 helicobacter pylori positive patients were divided into observation group （31 cases） and control group （31 eases） by random number table. Patients in negative control group and control group received Esomeprazole sodium for injection 40 mg during active bleeding, adding into 0.9% Sodium chloride injection 100 ml, intravenous infusion, twice a day, stopping clopodogrel and aspirin at the same time; after 3 d of active bleeding stopped, Clopidogrel and Aspirin. Based on conventional, observation group was additionally given Esomeprazole magnesium enteric-coated tablet 20 mg, orally, twice a day＋Amoxicillin capsule 1.0 g, orally, twice a day＋Clarithromycin tablet, orally, twice a day, for 2 weeks. After 1 month, by ＇4C breath test. Eradication losers were given Esomeprazole magnesium enteric-coated tablet 20 mg in the second 2 month af- ter treatment, orally, twice a day ＋ Bismuth potassium citrate capsule 0.3 g, orally, twice a day ＋ Amoxicillin capsule 1.0 g, orally, twice a day ＋ Levofloxacin tablet 0.5 g, orally, once a day, for 2 weeks. All patients were followed-up for six months. Relief time of pain and gastrointestinal symptoms, and the rebleeding situation in all groups were observed, the eradiation situation and the incidence of adverse reactions in observation group were recorded. RESULTS： After treatment for the first time, 22 patients eradiated helico- bacter pylori in observation group, with eradiation rate of 71.0%, the others were eradicated in the next treatment, the total eradiation rate was 100 %. The incidence of upper gastrointestinal rebleeding in observation group was significantly lower than control group and negative control group, with statistical significance （P〈 0.05）. And there were no significant differences in relief time of pain and gas- trointestinal symptoms, and the incidence of adverse reactions （P〉0.05）. CONCLUSIONS： Esomeprazole-based regimen can reduce the incidence of upper gastrointestinal bleeding induced by long-term clopodogrel combined with aspirin treatment, with good safety.