PCI术后双联抗血小板治疗危险性急性上消化道出血的危险因素分析

The clinical characteristics and risk factors of dangerous acute upper gastrointestinal bleeding in patients treated by double antiplatelet drugs after PCI

目的探讨PCI术后使用双联抗血小板药物治疗的患者,出现危险性急性上消化道出血的临床特征,分析其危险因素。方法收集2018年2月至2019年6月行PCI术且应用双联抗血小板治疗180例住院患者的临床资料,根据是否出现危险性急性上消化道出血,将其分为出血组与对照组。分析并比较患者年龄、性别、体重指数(BMI)、吸烟史、饮酒史、用药史(合并抗凝药华法林、阿司匹林、NSAID药物)、既往病史(消化道溃疡或消化道出血史、高血压病史、冠心病病史、脑梗死病史)情况、急性脑梗死及血红蛋白(Hb)、血小板(PLT)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、肌酐(Cr)等实验室检查指标,并对差异性指标做相关性分析。结果2组比较,患者的性别、饮酒史、BMI差异无统计学意义(P>0.05);而出血组中,患者年龄偏大,较多患者有吸烟史、消化性溃疡出血史、合并高血压病、冠心病、脑梗死病史,口服华法林史、阿司匹林、非甾体抗炎药(NSAIDS)等病史;合并急性脑梗死或幽门螺杆菌感染易出现出血。多出现Hb减低、PLT异常、Cr升高(P<0.05)。最终确定年龄、吸烟史、消化性溃疡出血史、高血压病史;口服华法林史;合并急性脑梗死,Hb减低、PLT异常、Cr升高为出血的独立危险因素。结论PCI术后双联抗血小板治疗患者危险性急性上消化道出血的影响因素较多,应加强对双联抗血小板药物治疗出现危险性急性上消化道出血的认识。要警惕高危因素,提早干预,定期监测出血指标,及早发现并采取适宜治疗措施,降低PCI患者消化道出血的发生率。

Objective To investigate the clinical characteristics of dangerous acute upper gastrointestinal bleeding in patients treated by double antiplatelet drugs after PCI,and to analyze its risk factors.Methods The clinical data of 180 inpatients who werew treated by PCI and double antiplatelet drugs in our hospital from April 2018 to January 2019 were collected,and the patients were divided into bleeding group and control group according to whether there was dangerous acute upper gastrointestinal bleeding or not.The patients’age,sex,body mass index(BMI),smoking history,drinking history,drug history(combined with anticoagulant warfarin,aspirin,NSAID drugs),previous history(gastrointestinal ulcer or gastrointestinal bleeding history,hypertension history,History of coronary heart disease,history of cerebral infarction),acute cerebral infarction and hemoglobin(Hb),platelet(PLT),glutamic pyruvic transaminase(ALT),glutamic oxaloacetic transaminase(AST),creatinine(Cr)were observed and compared between the two groups.Results There were no significant differences in patient’s sex,drinking history and body mass index(BMI)between the two groups(P>0.05).In bleeding group,the patients were older,and more patients had a history of smoking,peptic ulcer bleeding,hypertension,coronary heart disease,cerebral infarction,oral warfarin,aspirin,non-steroidal anti-inflammatory drug(NSAIDS),and the patients who were complicated by acute cerebral infarction or Helicobacter pylori infection were prone to bleeding.The decrease of Hb,the abnormality of PLT and the increase of Cr were found in most patients(P<0.05).Finally,patient’s age,smoking history,peptic ulcer bleeding history,hypertension history,oral warfarin history,combined with acute cerebral infarction,and decrease of Hb,the abnormality of PLT and the increase of Cr were the independent risk factors of hemorrhage.Conclusion There are many factors affecting the risk of acute upper gastrointestinal bleeding in patients receiving double antiplatelet therapy after PCI,therefor,it is necessary to pay much attention to the high-risk factors,to early interfere,regularly monitor the bleeding indexes,early detect and take appropriate treatment measures to reduce the incidence of gastrointestinal bleeding in patients after PCI.