目的 探讨急性冠脉综合征抗栓治疗患者发生院内出血的危险因素.方法 纳入936例急性冠脉综合征阿斯匹林及氯吡格雷进行抗栓治疗的患者,对其年龄,性别,既往粘膜、腔道出血史,心绞痛病史等20项可能出血的因素指标与发生院内出血及分级进行单因素分析,对单因素有意义危险因素再进行多因素logistic回归分析.结果 ACS患者总的出血发生率为3.10%,大出血发生率为1.06%,其中不稳定型心绞痛、非ST段抬高型心肌梗死、ST段抬高型心肌梗死的患者大出血发生率分别是0.76%、1.44%及1.51%.经多因素logistic回归分析,年龄,既往粘膜、腔道出血史,体重指数,血红蛋白,内生肌酐清除率5项因素,为ACS患者出血的主要影响因素.结论 年龄,既往粘膜、腔道出血史,体重指数,血红蛋白,内生肌酐清除率是急性冠脉综合征单纯抗栓治疗发生院内出血的危险因素,但临床仍需更大样本病例进一步证实.%Objective To investigate the risk factors of nosocomial bleeding after simple anticoagulant treatment in patients with acute coronary syndrome ( ACS ). Methods In 936 ACS patients, age, sex, history of mucous or cavity hemorrhage, history of angina and smoking, complicated hypertension or diabetes, body mass index ( BMI ), and blood pressure,platelet count, hemoglobin, NYHA class, NT-pro-BNP, cTnI, creatinine clearance rate,FBG,CRF and TC,and nosocomial bleeding and grading were given single-factor analysis. The multiple Logistic regression analysis was conducted to significant risk factors. Results The total incidence of bleeding was 3. 10% in ACS patients, and incidence of major bleeding was 1.06% . The incidence of major bleeding was 0. 76% in patients with unstable angina, 1. 44% in those with non-ST-segment elevation myocardial infarction and 1. 51% in those with ST-segment elevation myocardial infarction. The multifactor Logistic regression analysis showed that age, history of mucous or cavity hemorrhage, BMI, hemoglobin and creatinine clearance rate were main influence factors of bleeding in ACS patients. Conclusion Age, history of mucous or cavity hemorrhage, BMI, hemoglobin and creatinine clearance rate are risk factors of nosocomial bleeding after simple anticoagulant treatment in ACS patients,but larger sample in clinic is required for further confirmation.
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