PCI术后合并上消化道出血临床分析

Clinical observation of undergoing percutaneous coronary intervention complicated by upper gastrointestinal hemorrhage

目的探讨PCI术后合并上消化道出血(Upper gastrointestinal hematorrhea,UGIH)相关因素及抗栓药物调整的近期疗效及安全性。方法选择464例在我院接受PCI患者的临床资料,分析PCI术后发生UGIH相关因素;观察UGIH患者抗栓药物调整后住院期间及术后1个月内支架内血栓发生情况。结果 UGIH发生率为3.0%(14/464)。PCI围术期使用质子泵抑制剂的患者UGIH发生率(1.2%)与未使用的患者(8.4%)比较,差异有统计学意义(P<0.05)。高龄、糖尿病、急性心肌梗死、PCI操作时间长的患者UGIH发生率较高,分别为4.6%、5.1%、7.1%和5.5%,差异有统计学意义(P<0.05),PCI术后合并UGIH患者住院期间及术后1月无1例发生支架内血栓。结论 PCI围术期应用质子泵抑制剂减少UGIH发生率,而糖尿病、高龄、急性心肌梗死、PCI操作时间为UGIH危险因素,PCI术后合并UGIH患者抗栓药物调整不增加支架内血栓发生率。

Objective To study the related factors of patients with upper gastrointestinal hemor rhage undergoing percutaneous coronary intervention and observe the short term safety and effect of anti platelet drugs adjustment in patients who underwent upper gastrointestinal hemorrhage during percutaneous coronary intervention （PCI）. Methods The clinical data of 464 patients un derwent PCI were retrospectively analyzed. The related factors for gastrointestinal bleeding after percutaneous coronary intervention were analyzed. The anti platelet drugs were adjusted,the oc currence of in stent thrombosis during every hospitalization period and 1 months were analyzed. Results UGIH occurred in 14 out of 464 PCI patients （3.0%）. The incidence of UGIH in pa tients given proton pump inhibitors during perioperative period and in patients not given these drugs was 1.2% and 8.4% respectively, there was a significant difference （P〈0.05）. The oc currence of upper gastrointestinal hemorrhage is high among the patients complicated by aged,di abetes, acute myocardial infarct ion and the long operation time of PCI were 4. 4 %, 5.1%, 7.1 %and 5.5 % respectively. There were significant differences （P〈0.05）. For those who underwent GIB circa PCI, there was no case of upper stent thrombosis events during hospitalization period and 1 months after discharge. Conclusion Application of PPIS could reduce the risk of upper gas trointestinal hemorrhage in perioperative period of PCI. It showed that multiple health factors, including diabetes, age, acute myocardial infarct ion and the operation time of PCI, could increase the possibility of developing upper gastrointestinal hemorrhage. The adjustment of anti-plateletdrugs has no effect on the risk of possible stent thrombosis after PCI.