泮托拉唑和吉法酯治疗双联抗血小板所致上消化道出血的对比研究

Comparison of Efficacy Between Pantoprazole and Gefarnate in Treating Upper Gastrointestinal Bleeding Caused by PostPCI Dual Anti-platelet Therapy

目的探讨质子泵抑制剂(proton pump inhibitor,PPI)泮托拉唑和胃黏膜保护剂吉法酯对经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后服用双联抗血小板药物患者上消化道出血的预防效果。方法 1263例PCI术后服用肠溶阿司匹林合并氯吡格雷纳入本研究,按治疗小组分为4组:常规治疗组(n=332)、PPI组(n=318)、胃黏膜保护剂组(n=299)、PPI+胃黏膜保护剂组(n=314)。随访6个月,观察患者的消化道症状、上消化道出血、主要心脏不良事件(major adverse cardiac events,MACE)、不良反应等。结果 52例6个月内发生上消化道出血,其中常规治疗组21例,PPI组9例,胃黏膜保护剂组15例,PPI+胃黏膜保护剂组7例,4组6个月内上消化道出血发生率有统计学差异(χ~2=8.883,P=0.031),其中常规治疗组显著高于PPI组和PPI+胃黏膜保护剂组(P<0.05),其他各组间消化道出血发生率无统计学差异(P>0.05)。术后3个月内发生上消化道出血34例,占全部上消化道出血65.4%(34/52),4组消化道出血的发生时间无统计学差异(χ2=4.212,P=0.648)。结论泮托拉唑或泮托拉唑联合吉法酯口服可降低PCI术后双联抗血小板药物患者上消化道出血的发生率。上消化道出血的预防性治疗应从PCI术后第1天开始,至少维持3~6个月,甚至更长。

Objective To investigate the effect of pantoprazole（proton pump inhibitor,PPI） and gefarnate（gastric mucosa protectant） on the prevention of upper gastrointestinal bleeding in patients undergoing post-percutaneous coronary intervention（PCI）dual anti-platelet therapy. Methods This research included 1263 patients taking enteric aspirin and clopidogrel after PCI. The cases were divided into 4 groups：routine treatment group（n = 332）,PPI group（n = 318）,gastric mucosa protectant group（n =299）,and PPI ＋ gastric mucosa protectant group（n = 314）. A follow-up for 6 months was observed including gastrointestinal symptoms,upper gastrointestinal bleeding,major adverse cardiac events（MACE）,and adverse reactions. Results There were 52 cases of upper gastrointestinal bleeding within 6 months,including 21 cases from routine treatment group,9 from PPI group,15 from gastric mucosa protectant group,and 7 from PPI ＋ gastric mucosa protectant group. The incidence of upper gastrointestinal bleeding among the 4 groups within 6 months was statistically different（χ^2= 8. 883,P = 0. 031）. The routine treatment group had significant higher rate than the PPI group and the gastric mucosa protectant group（P〈0. 05）,while among other groups there was no significant difference（P〉0. 05）. The upper gastrointestinal bleeding occurred within 3 postoperative months in 34 out of 52 cases（65. 4%）.There was no statistical significance among the four groups in regard to bleeding occurrence time（χ^2= 4. 212,P = 0. 648）.Conclusions Patients undergoing post-PCI dual anti-platelet treatment can reduce the incidence of gastrointestinal bleeding by taking pantoprazole or combined with gefarnate. Intervention against upper gastrointestinal bleeding should start on the first day after PCI and last for a minimum of 3-6 months.