基于CRUSADE评分系统探讨质子泵抑制剂在预防经皮冠状动脉介入治疗术后消化道出血中的价值

Value of proton pump inhibitors in preventing gastrointestinal bleeding after percutaneous coronary intervention based on CRUSADE scoring system

目的运用CRUSADE评分系统,探讨质子泵抑制剂在预防经皮冠状动脉介入治疗(PCI)术后消化道出血中的价值。方法前瞻性纳入华北医疗健康集团峰峰总医院心内科2018年3月—2021年12月收治的接受支架植入治疗的冠心病患者600例,依据CRUSADE评分系统的危险分层,把极低危、低危的归为低危分层组,中危、高危、很高危的归为中高危组,各危险分层按1∶1比例随机分为对照组与试验组,各组患者在PCI术前、术后均给予阿司匹林肠溶片、硫酸氢氯吡格雷片口服,试验组在此基础上给予联合质子泵抑制剂(雷贝拉唑肠溶片每天20 mg或泮托拉唑钠肠溶片每天40 mg)自PCI术前至术后连续服药3个月。随访12个月,观察各组患者消化道出血事件以及主要心脑血管不良事件发生情况。结果根据CRUSADE评分的不同,中高危分层对照组较低危分层对照组的消化道出血事件明显增加,差异有统计学意义(P<0.05)。同时,与低危分层对照组相比,低危分层试验组消化道出血事件发生率未见明显差异(P>0.05)。中高危分层试验组消化道出血事件发生率较中高危分层对照组明显减少,差异有统计学意义(P<0.05)。在同一类CRUSADE评分系统危险分层中,试验组和对照组患者主要心脑血管不良事件发生率未见明显差异(P>0.05)。结论应用CRUSADE评分系统进行危险分层,干预出血高危风险患者,PCI术后加用质子泵抑制剂可有效预防消化道出血,且未增加心脑血管不良事件风险。

Objective To explore the value of proton pump inhibitors in the prevention of gastrointestinal bleeding after percutaneous coronary intervention(PCI)using CRUSADE scoring system.Methods Prospectively included 600 patients with coronary heart disease who received stent implantation treatment in the Department of Cardiology,Fengfeng General Hospital,North China Medical and Health Group from March 2018 to December 2021.According to the risk stratification of the CRUSADE scoring system,the extremely low risk and low risk patients were classified into low risk stratification group,the medium risk,high risk and very high risk patients were classified into medium high risk group,and each risk stratification was randomly divided into control group and test group according to the ratio of 1∶1.The patients in each group were divided into two groups before PCI After the operation,aspirin and clopidogrel were given orally.On this basis,the test group was given a combined proton pump inhibitor(rabeprazole 20 mg per day or pantoprazole 40 mg per day)for 3 months from the pre-operation to the post-operation.Follow up for 12 months,and observe the occurrence of gastrointestinal bleeding events and major cardiovascular and cerebrovascular adverse events in each group.Results According to the different CRUSADE scores,the incidence of gastrointestinal bleeding in the middle-high risk stratified control group was significantly higher than that in the low-risk stratified control group(P<0.05).At the same time,compared with the low-risk stratified control group,there was no significant difference in the incidence of gastrointestinal bleeding events in the low-risk stratified test group(P>0.05).The incidence of gastrointestinal bleeding in the middle and high risk stratified test group was significantly lower than that in the middle and high risk stratified control group(P<0.05).In the risk stratification of the same CRUSADE scoring system,there was no significant difference in the incidence of major cardiovascular and cerebrovascular adverse events between the test group and the control group(P>0.05).Conclusion The use of CRUSADE scoring system for risk stratification,intervention of high-risk patients with bleeding,and the use of proton pump inhibitors after PCI can effectively prevent gastrointestinal bleeding without increasing the risk of cardiovascular and cerebrovascular adverse events.