冠状动脉粥样硬化性心脏病患者经皮冠状动脉介入术后双联抗血小板治疗过程中合并上消化道出血的临床特点分析

摘要

目的 探讨冠状动脉粥样硬化性心脏病(冠心病)患者经皮冠状动脉介入(PCI)术后双联抗血小板治疗过程中上消化道出血的临床特点.方法 收集2013年7月至2014年10月于首都医科大学附属北京安贞医院就诊的冠心病PCI术后合并上消化道出血患者56例的病历资料,根据PCI术后出血时间分为早期组(≤6个月,24例)和晚期组(＞6个月,32例),比较2组患者性别、年龄、高血压、糖尿病、吸烟史、饮酒史、既往病史、药物治疗、实验室检查等指标.结果 早期组既往心肌梗死患者比例明显高于晚期组[33.3％ (8/24)比15.6％(5/32)],既往消化性溃疡患者比例及血肌酐水平明显低于晚期组[16.7％(4/24)比31.2％ (10/32)、(68-14) mmol/L比(87±15) mmol/L],差异均有统计学意义(均P＜0.05).2组余各指标差异均无统计学意义(均P＞0.05).2组轻度和中度出血患者比例差异无统计学意义(P＞0.05).早期组重度出血患者比例明显高于晚期组[16.7％ (4/24)比9.4％(3/32)],差异有统计学意义(P＜0.05).结论 患者既往心肌梗死病史与早期上消化道出血密切相关,既往消化性溃疡病史、血肌酐水平与晚期上消化道出血密切相关;早期上消化道出血患者出血程度较重.%Objective To explore the clinical features of upper gastrointestinal bleeding in dual antiplatelet treatment after percutaneous coronary intervention (PCI) in patients with coronary artery disease.Methods Totally 56 patients with upper gastrointestinal bleeding after PCI from July 2013 to October 2014 were enrolled and divided into 2 groups by bleeding time after PCI:early stage group (≤ 6 months,24 cases) and late stage group (＞ 6 months,32 cases).Gender,age,the history of hypertension,diabetes,smoking,drinking,myocardial infarction,peptic ulcer disease,upper gastrointestinal bleeding,the history of medical therapy and laboratory examination results were analyzed.Results In early stage group,the rate of myocardial infarction history was significantly higher than that in late stage group [33.3％ (8/24) vs 15.6％ (5/32)],the rate of peptic ulcer disease history and the level of creatinine were significantly lower than those in late stage group [16.7％ (4/24) vs 31.2 ％ (10/32),(68 ± 14) mmol/L vs (87 ± 15) mmol/L] (P ＜ 0.05).The other indexes had no significantly differences(P ＞0.05).The rates of mild and moderate bleeding between groups had no significantly differences (P ＞ 0.05).The rate of severe bleeding in early stage group was significantly higher than that in late stage group [16.7％ (4/24) vs 9.4％ (3/32)] (P ＜ 0.05).Conclusions The history of myocardial infarction is related with upper gastrointestinal bleeding at the early stage.The history of peptic ulcer disease and the level of creatinine are related with upper gastrointestinal bleeding at late stage.The incidence of severe upper gastrointestinal bleeding is higher at early stage than late stage.