关于冠脉介入术患者双重抗血小板治疗后发生上消化道出血的临床分析

Upper Gastrointestinal Bleeding in Patients Taking Dual Antiplatelet Therapy after Percutaneous Coronary Intervention

目的:探讨急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后服用双重抗血小板药物后上消化道出血(UGIB)发生率、临床特征及危险因素。方法:回顾性分析2012年9月至2016年8月就诊于中山大学孙逸仙纪念医院因ACS而行PCI治疗的患者资料,根据患者服用阿司匹林联合氯吡格雷双重抗血小板治疗1年内是否发生上消化道出血分为UGIB组和对照组,比较两组之间的临床特点,筛选发生UGIB的相关危险因素。结果:ACS患者PCI后双抗治疗1年内的UGIB发生率是5.2%;与对照组比较,UGIB组年龄大、女性、消化性溃疡史、肾功能不全及心功能不全比例均明显升高(P均<0.05);logistic回归分析后显示:女性、年龄、消化性溃疡史、肾功能不全及心功能不全史是ACS患者PCI后口服双重抗血小板药物治疗发生上消化道出血的独立危险因素(P<0.05)。结论:对ACS患者PCI后服用双重抗血小板治疗时,应全面评估UGIB危险因素,高危患者应加强随访并采取避免出血的临床对策。

Objective： To investigate the incidence, clinical characteristics and risk factors of upper gastrointestinal bleeding （UGIB）in patients with acute coronary syndrome （ACS） administrated with aspirin and clopidogrel dual anti-platelet therapy after percutaneous coronary intervention （PCI）. Methods ： Patients with ACS who had undergone PCI in Sun Yat-sen Memorial Hospital from Sep 2012 to Aug 2016 were retrospectively enrolled. All patients were treated by aspirin and clopidogrel dual anti-platelet in 1 year were divided into UGIB group and control group. The incidence, clinical characteristics and risk factor of UGIB were analyzed. Results ： The incidence of UGIB in patients with ACS administrated with aspirin and clopidogrel dual anti-platelet therapy after PCI was 5.2 percent. The age was significantly older, the proportion of female patients was significantly higher than that of male patients （P〈0.05 respectively）. The incidence of previous history of peptic ulcer, abnormal renal function and cardiac dysfunction were significantly higher in UGIB group than those in control group （P〈0.05）. Multivariate logistic regression analysis showed that age, female, previous history of peptic ulcer, abnormal renal function, cardiac dysfunction were the independent risk factors （P〈O.05）. Conclusion： The risk factors of UGIB in patients with ACS administrated with aspirin and clopidogrel dual antiplatelet therapy after PCI should be evaluated comprehensively, and for high-risk patients, follow-up should be strengthened and clinical measures should be taken to avoid bleeding.