不同抗血小板治疗方案对上消化道出血发生率的影响

董易学等

[摘要] 目的 分析不同的抗血小板药物治疗方案对上消化道出血发生率的影响。 方法 选取第三军医大学新桥医院2013年10月～2015年2月收治的心脑血管疾病合并上消化道出血患者180例作为研究对象，回顾性分析其临床资料，根据其是否曾服用过抗血小板药物将其分为非药物组（对照组，68例）和药物组（观察组，112例），然后根据其使用的抗血小板药物种类又将观察组分为阿司匹林组（66例）、氯吡格雷组（21例）和联用组（25例）。比较各组患者的各临床指标及其出血情况。 结果 经过不同的抗血小板治疗后，观察组消化道出血率明显高于对照组，住院时间明显短于对照组，出血前腹痛发生率明显低于对照组，差异均有统计学意义（均P < 0.05）。观察组患者的消化道出血方式主要表现为黑便，且内镜下的临床表现为胃溃疡和十二指肠溃疡，但阿司匹林组、氯吡格雷组和联用组在消化道出血方式、出血率及在内镜下的临床表现方面差异均无统计学意义（均P > 0.05）。对观察组患者进行单因素分析，消化道出血与年龄及幽门螺杆菌感染相关（P < 0.05），但与性别、服药时间、既往溃疡病史和出血史、脑动脉及冠状动脉支架的置入情况及质子泵抑制剂的使用均无相关性（P > 0.05）。对观察组患者进行多因素Logistic回归分析，患者的年龄及幽门螺杆菌感染情况均与消化道出血发生率密切相关（P < 0.05）。结论 心脑血管疾病患者服用抗血小板类药物可增加上消化道出血发生率，且出血前其腹痛症状较少见，临床上表现为黑便及消化性溃疡。阿司匹林与氯吡格雷单用或者联用对上消化道出血均无明显影响，而年龄及幽门螺杆菌感染情况是其出血发生的主要影响因素。

[关键词] 抗血小板；治疗方案；上消化道出血；影响因素

[中图分类号] R573 [文献标识码] A [文章编号] 1673-7210（2015）05（c）-0128-05

[Abstract] Objective To analyze the effect of different anti-platelet therapeutic schedules for incidence of upper gastrointestinal hemorrhage. Methods 180 patients with cardiovascular and cerebrovascular diseases in combination with upper gastrointestinal hemorrhage admitted to Xinqiao Hospital， Third Military Medical University from October 2013 to February 2015 were selected as research subjects， and the clinical data was analyzed retrospectively. According to whether the patients took the anti-platelets， they were divided into non-drug group （control group， 68 cases） and drug group （observation group， 112 cases）， then according to different kinds of anti-platelets， the patients of observation group were divided into Aspirin group （66 cases）， Clopidogrel group （21 cases） and combined group （25 cases）. The clinical indexes and bleeding conditions of all groups were compared. Results After different therapies of anti-platelets， the rate of gastrointestinal bleeding in observation group was higher than that of control group， the hospital stay was shorter than that of control group， the incidence of stomachache before bleeding was lower than that of control group， the differences were all statistically significant （all P < 0.05）. The gastrointestinal hemorrhage way of observation group mainly showed melena， and the clinical manifestation under endoscopic was gastric ulcer and duodenal ulcer， while there were no statistically significant differences in gastrointestinal hemorrhage way， hemorrhagic rate and clinical manifestation under endoscopic among Aspirin group， Clopidogrel group and combined group （all P > 0.05）. Single factor analysis for observation group showed that， gastrointestinal hemorrhage was related to age and Hp infection （P < 0.05）， while it had no correlation with sex， time of taking medicine， previous ulcer history and hemorrhage history， cerebral and coronary stent placement conditions and use of proton pump inhibitor （P > 0.05）. Multivariate Logistic regression analysis for observation group showed that， the age and Hp infection had close correlation with gastrointestinal hemorrhage （P < 0.05）. Conclusion The patients with cardiovascular and cerebrovascular diseases taking anti-platelet drugs can increase the rate of upper gastrointestinal hemorrhage， and the abdominal pain is less， which shows melena and peptic ulcer in clinic. The single use of Aspirin and Clopidogrel or combined use has no obvious influence on upper gastrointestinal hemorrhage， while the age and Hp infection are the main influencing factors of gastrointestinal hemorrhage.

[Key words] Anti-platelet； Therapeutic schedules； Upper gastrointestinal hemorrhage； Influencing factors

目前临床上常采用氯吡格雷及阿司匹林等抗血小板药物用于治疗心脑血管疾病，如心肌梗死、房颤、脑梗死、起搏器植入术后、心脏支架术后及短暂性脑缺血[1]，同时还具有预防血栓形成及防止患者猝死的作用。长期过度使用该类药物常常会对患者的胃肠道造成一定程度的损伤，引发消化道出血等严重的不良反应[2-3]。近年来由于抗血小板药物广泛应用而导致的胃肠道受损已经引起了广泛的关注。……