急性冠脉综合征患者PCI术后应用雷贝拉唑预防消化道出血的对比研究

Comparative Study of Rabeprazole in Preventing Gastrointestinal Bleeding in Patients with Acute Coronary Syndrome after PCI

目的探究雷贝拉唑在预防急性冠脉综合征PCI术后患者消化道出血的效果。方法选择2017年3月-2018年3月76例济宁市第一人民医院心内科收治的急性冠脉综合征行PCI术患者为研究对象。采用随机数字表法分为对照组(A组)38例,观察组(B组)38例。A、B两组患者在PCI术前均采用阿司匹林和氯吡格雷双联抗血小板治疗及常规治疗,A组不加用雷贝拉唑肠溶片;B组加用雷贝拉唑肠溶片20 mg/d,连续服用12个月。观察并比较两组患者消化道出血及心血管事件发生率。结果对照组血小板聚集抑制率为(33.7±0.49)%,雷贝拉唑组为(31.3±1.47)%,差异无统计学意义(t=0.096,P=0.891);治疗前,两组患者血红蛋白(Hb)水平差异无统计学意义,经治疗后均有变化,且两组差异有统计学意义(t=2.107,P=0.035);与对照组相比,雷贝拉唑组大便常规加隐血事件发生率明显较对照组低(χ^2=8.297,P=0.004),心血管事件发生率差异无统计学意义(χ^2=1.909,P=0.167)。结论急性冠脉综合征患者PCI术后加用雷贝拉唑,可有效降低消化道出血发生率,不影响血小板聚集率,不增加心血管事件风险,安全性和有效性均较高,值得在临床上推广使用。

Objective To investigate the effect of rabeprazole in preventing gastrointestinal bleeding in patients with acute coronary syndrome after PCI. Methods From March 2017 to March 2018, 76 patients with acute coronary syndrome who underwent PCI in Jining First People’s Hospital were selected as the research subjects. Random number table method was used to divide the control group(group A) into 38 cases and the observation group(group B) into 38 cases. Patients in groups A and B were treated with aspirin and clopidogrel dual antiplatelet therapy and conventional treatment before PCI. Group A did not add rabeprazole enteric-coated tablets;group B added rabeprazole enteric-coated tablets 20 mg/d for 12 months. Observe and compare the incidence of gastrointestinal bleeding and cardiovascular events in the two groups of patients. Results The platelet aggregation inhibition rate was(33.7±0.49)%in the control group and(31.3±1.47)% in the rabeprazole group, and the difference was not statistically significant(t=0.096, P=0.891). Before treatment, the hemoglobin(Hb) of the two groups of patients of the difference in levels was not statistically significant, and both were changed after treatment, and the differences between the two groups were statistically significant(t=2.107, P=0.035);compared with the control group, the incidence of routine stool and occult blood events in the rabeprazole group was significantly lower than the control group(χ^2= 8.297, P=0.004), and there was no significant difference in the incidence of cardiovascular events(χ^2=1.909, P=0.167). Conclusion The addition of rabeprazole after PCI in patients with acute coronary syndrome can effectively reduce the incidence of gastrointestinal bleeding, does not affect the platelet aggregation rate, does not increase the risk of cardiovascular events, and has high safety and effectiveness, which should be promoted clinically.