摘要
目的评价经皮冠状动脉介入(PCI)术后合并急性胃黏膜病变出血后应用抗血小板治疗的疗效,探讨有效的治疗方案,以改善患者预后。方法选取2017年11月至2018年11月就诊的PCI术后6个月内合并急性胃黏膜病变出血患者120例,随机分为3组,每组40例,3组均予以相同的抑酸、止血、补液营养支持治疗;A组为出血后14 d加用拜阿司匹林100 mg/d联合氯吡格雷75 mg/d治疗;B组为出血后5 d加用拜阿司匹林100 mg/d联合氯吡格雷75 mg/d治疗;C组为出血后5 d单用替格瑞洛90 mg,2次/d;以治疗后1个月、3个月为时间截点,对比3组的再缺血事件发生率、血管内血栓形成比率以及再出血发生率。结果B组治疗后1个月、3个月的再缺血事件发生率与血管内血栓形成比率均低于A组(P<0.05);C组治疗后1个月、3个月的再缺血事件发生率与血管内血栓形成比率均低于B组(P<0.05)。B组治疗后1个月、3个月的再出血发生率与A组相近,差异无统计学意义(P>0.05);C组治疗后1个月、3个月的再出血发生率与B组相近,差异无统计学意义(P>0.05)。结论PCI术后合并急性胃黏膜病变出血后尽早抗血小板治疗能够明显降低再缺血事件及预防支架内血栓形成发生,而不增加再出血风险;PCI术后合并急性胃黏膜病变出血后3个月内单一使用替格瑞洛抗血小板治疗的应用效果优于双抗联合抗血小板治疗;短期内单一抗血小板治疗更安全。
Objective To investigate the clinical efficacy of antiplatelet therapy in patients with acute gastric mucosal bleeding after percutaneous coronary intervention(PCI),and to explore the effective treatment plan to improve the prognosis of patients.Methods A total of 120 patients with acute gastric mucosal bleeding within 6 months after PCI who were treated in our hospital from November 2017 to November 2018 were enrolled in the study,who were randomly divided into three groups,with 40 cases in each group.The patients in the three groups were given the same therapy including acid inhibition,hemostasis and rehydration nutrition support,on this basis,the patients in group A were treated by aspirin 100mg/d combined with clopidogrel 75mg/d at 14d after bleeding,and the patients in group B were treated by aspirin 100mg/d combined with clopidogrel 75mg/d at 5d after bleeding,and the patients in group C were treated by ticagrelor 90 mg,twice a day at 5d after bleeding.The incidence of ischemic events,intravascular thrombosis rate and rebleeding rate at 1m,3m after treatment were observed and compared among the three groups.Results The incidence rates of ischemic events and intravascular thrombosis at 1m,3m after treatment in group B were significantly lower than those in group A(P<0.05),which in group C were significantly lower than those in group B(P<0.05).However there were no significant differences in the incidence rates of ischemic events and intravascular thrombosis at 1m,3m after treatment between group B and group A(P>0.05),nor were between group C and group B(P>0.05).Conclusion The early antiplatelet therapy in patients with acute gastric mucosal bleeding after PCI can significantly reduce the incidence of re-ischemia events and prevent the occurrence of stent thrombosis without increasing the risk of rebleeding,moreover,the therapeutic effects of simple antiplatelet therapy with ticagrelor at 3m after PCI are superior to those by double antibody combined with antiplatelet therapy.
作者
刘茗
杨东红
张静
LIU Ming;YANG Donghong;ZHANG Jing(Department of Gastroenterology,Langfang People’s Hospital,Hebei,Langfang 065000,China;不详)
出处
《河北医药》
CAS
2021年第24期3792-3794,共3页
Hebei Medical Journal
基金
廊坊市科技支撑计划项目(编号:2017013141)。
关键词
经皮冠状动脉介入术
急性胃黏膜病变出血
抗血小板治疗
再缺血事件
血管内血栓形成
再出血
percutaneous coronary intervention
acute gastric mucosal lesion bleeding
antiplatelet therapy
re-ischemic events
intravascular thrombosis
rebleeding
