活血化瘀类辅助药物对急性冠脉综合征患者上消化道出血的影响的回顾性分析

Retrospective Analysis of the Impact of the Adjuvant Huoxuehuayu Drugs on Upper Gastrointestinal Haemorrhage in Patients with Acute Coronary Syndrome

目的分析我院活血化瘀类辅助药物在急性冠脉综合征(acute coronary syndrome,ACS)患者中的使用情况,探讨该类药物对上消化道出血(upper gastrointestinal haemorrhage,UGH)的影响,为临床合理应用活血化瘀类辅助药物提供参考。方法选取我院2016年5月至7月ACS患者,根据是否使用活血化瘀类辅助药物分为4组:未使用活血化瘀辅助药物、使用1种活血化瘀辅助药物、使用2种活血化瘀辅助药物、使用≥3种活血化瘀辅助药物。收集患者的病史资料、治疗情况等基线数据,汇总活血化瘀类辅助药物使用情况,评估患者CRUSADE出血风险等级,并分析患者UGH发生频数。结果纳入ACS患者共503例,4组间既往病史、基础药物使用以及介入治疗频数之间无统计学差异。随着CRUSADE出血风险等级的递增,UGH发生率显著增加。极低危和低危出血风险的ACS患者,4组间的UGH发生率无显著性差异(P>0.05);中危与高危出血风险的ACS患者,使用2种与≥3种活血化瘀药患者的UGH发生率均明显高于未用活血化瘀药与使用1种活血化瘀药,差异有统计学意义,其他组之间无统计学差异;极高危出血风险的ACS患者,与使用1种活血化瘀药相比,使用2种与≥3种活血化瘀药患者的UGH发生率明显增加,P值分别为0.009,0.025(<0.05),有统计学差异。结论对于出血风险中危与高危的ACS患者,使用≥2种活血化瘀药会显著增加UGH风险;UGH发生率随着CRUSADE出血风险等级的递增而显著增加,对于极高危出血风险的ACS患者,更应严格控制活血化瘀药的使用。

OBJECTIVE To analyze the usage of the adjuvant huoxuehuayu drugs in patients with acute coronary syndrome （ ACS）, observe the impact of the drugs on upper gastrointestinal haemorrhage（ UGH）, and provide a reference for the clinical ra- tional use of the adjuvant huoxuehuayu drugs. METHODS The ACS patients were enrolled in our hospital during May to July 2016. And the patients were divided into four groups according to whether using the adjuvant huoxuehuayu drugs： not use, used one kind, used two kinds, used t〉 three kinds of huoxuehuayu drugs. Then we collected medical history, therapeutic measures and other baseline data, gathered the data of the usage of the adjuvant huoxuehuayu drugs, evaluated CRUSADE bleeding risk and analyzed frequency of occurrence of UGH. RESULTS Overall 503 ACS patients were enrolled, there was no significant differences among the four groups when the medical history, essential medicines and intervene frequency were compared respec- tively. On the other hand, the incidence rate of UGH increased significantly with CRUSADE bleeding risk rank increasing incre- mentally. For very low and low bleeding risk ACS patients, there were no significant differences in UGH incidence rate among the four groups; For moderate and high bleeding risk ACS patients, UGH incidence rate increased significantly in ACS patients using more than one kind of huoxuehuayu drugs compared with other two groups（ P 〈 0.05 ）. For very high bleeding risk ACS patients, UGH incidence rate increased significantly in ACS patients using 2 and ≥3 kinds of huoxuehuayu drugs compared with patients u- sing one kind drug, P = 0. 009,0. 025 respectively. CONCLUSION For moderate and high bleeding risk ACS patients, UGH incidence rate increase significantly in ACS patients using ≥2 kinds of huoxuehuayu drugs. A significant increase in the in- cidence rate of UGH with CRUSADE bleeding risk rank increasing, the use of huoxuehuayu drugs shoud be controled strictly, es- pecially for very high bleeding risk ACS patients.