双联抗血小板联合质子泵抑制剂治疗急性心肌梗死对患者预后的影响

Effect of dual antiplatelet therapy combined with proton pump inhibitor on prognosis in the treatment of patients with acute myocardial infarction

目的探讨急性心肌梗死(AMI)应用双联抗血小板联合质子泵抑制剂(PPI)治疗对患者预后的影响。方法选择原广州军区总医院心内科及我院综合内科于2014年1月至2016年6月期间收治的468例AMI患者为研究对象,根据随机数表法分为A、B、C三组,每组156例,所有患者均接受经皮冠状动脉介入(PCI)支架置入治疗,术后接受阿司匹林+氯吡格雷双联抗血小板治疗,A组不应用PPI,B组应用奥美拉唑,C组应用埃索美拉唑治疗,疗程6个月。比较治疗后三组患者主要不良心血管事件(MACE)、上消化道出血及支架内血栓形成情况。结果 A、B、C三组患者的MACE及支架内血栓形成发生率分别为9.63%和1.92%、15.38%和5.13%、13.46%和3.21%,两两比较差异均无统计学意义(P>0.05);B组和C组上消化道出血的发生率分别为3.85%和1.92%,明显低于A组的9.63%,差异均有统计学意义(P<0.05)。结论 PCI术后双联抗血小板治疗过程中,加用奥美拉唑或埃索美拉唑均可有效预防上消化道出血的发生,且不增加心血管事件的发生风险。

Objective To investigate the effect of dual antiplatelet therapy combined with proton pump inhibitor（PPI） on the prognosis of patients with acute myocardial infarction（AMI）. Methods A total of 468 cases of patients with AMI, who admitted to Department of Cardiology in our hospital during January 2014 to June 2016, were selected and divided into A, B, C three groups according to random number method, with 156 cases in each group. All the patients were treated with percutaneous coronary intervention（PCI） stent implantation, and received aspirin＋clopidogrel Gray dual antiplatelet therapy after the PCI. without using PPI in A group, omeprazole and esomeprazole treatment were respectively used in B group and C group, the three groups treatment for 6 months. After the treatment, the main adverse cardiovascular events（MACE）, upper gastrointestinal bleeding and stent thrombosis rate were compared between the three groups. Results The incidence rate of MACE and stent thrombosis in the three group of A, B, C were respectively 9.63% and 1.92%, 15.38%and 5.13%, 13.46% and 3.21%, showed no significant difference between them（P〈0.05）; The upper gastrointestinal bleeding rates in the B group and the C group were 3.85% and 1.92%, which were significantly lower than 9.63% in the A group（P〈0.05）. Conclusion Omeprazole and esomeprazole can not only effectively prevent the occurrence of upper gastrointestinal bleeding in patients with dual antiplatelet therapy after PCI, but also do not increase the risk of cardiovascular events.