泮托拉唑钠联合氯吡格雷治疗急性心肌梗死伴消化道出血的安全性和有效性研究

Safety and efficacy of pantoprazole sodium plus clopidogrel in the treatment of acute myocardial infarction combined with digestive tract hemorrhage

目的:探讨泮托拉唑钠联合氯吡格雷治疗急性心肌梗死伴消化道出血的安全性和有效性。方法:2015年1月至2017年3月某院收治的AMI伴消化道出血90例患者,随机分为治疗组和对照组,每组各45例。治疗组患者给予氯吡格雷75mg,qd,口服;泮托拉唑钠40 mg溶于0.9%氯化钠注射液100 mL,qd,静滴。对照组患者给予氯吡格雷75 mg,qd,口服;奥美拉唑20 mg,bid。所有患者均治疗1周。检测治疗前和治疗后3,5,7 d血清PGE2水平;观察疗效、药物不良反应、治疗3个月后不良心血管事件的发生率。结果:治疗组治疗3,5,7 d后血清PGE2分别为(80.24±15.37)、(115.27±22.54)、(150.24±30.01)ng·mL^(-1),明显高于对照组的(66.35±13.57)、(92.35±18.34)、(120.98±36.41)ng·mL^(-1),差异有显著性(P<0.05)。治疗组治疗有效率为84.44%,明显高于对照组的60.00%,差异有显著性(P<0.05)。治疗组不良反应和不良心血管事件的发生率均为6.66%,而对照组分别为4.44%和8.88%,2组比较无显著性差异(P>0.05)。结论:泮托拉唑钠联合氯吡格雷治疗急性心肌梗死伴消化道出血的临床疗效显著,可提高血清PGE2水平,且不增加药物不良反应和心血管事件的发生率。

OBJECTIVE To investigate the safety and efficacy of pantoprazole sodium plus clopidogrel in the treatment of acute myocardial infarction combined with digestive tract hemorrhage.METHODS Totally 90 patients with acute myocardial infarction combined with digestive tract hemorrhage from January 2015 to March2017 were randomly divided into the experimental group and the control group.The patients in the experimental group received clopidogrel 75 mg,qd,orally,pantoprazole sodium40 mg dissolved in 0.9% sodium chloride injection 100 mL,qd,by intravenous drip.The patients in the control group received clopidogrel 75 mg,qd,orally,omeprazole 20 mg,bid.All patients were treated for 1 week.The serum levels of PGE2 after3 d,5 d,7 d of treatment were detected.Efficacy,the incidence of adverse drug reactions and adverse cardiovascular events after3 months of treatment were observed.RESULTS The serum PGE2 values after 3 d,5 d and 7 d of treatment in the experimental group were（80.24±15.37）,（115.27±22.54）,（150.24±30.01）ng·mL^-1,higher than those in the control group[（66.35±13.57）,（92.35±18.34）and（120.98±36.41）ng·mL^-1]（P〈0.05）.The efficacy in the experimental group was 84.44%,higher than that in the control group（60.00%）（P〈0.05）.There was no significant difference between two groups in the incidence of adverse drug reactions and adverse cardiovascular events（P〉0.05）.CONCLUSION Pantoprazole sodium plus clopidogrel is effective in the treatment of acute myocardial infarction combined with digestive tract hemorrhage,can improve serum PGE2 level,and does not increase the incidence of adverse drug reactions and cardiovascular events.