冠心病患者双联抗血小板治疗中上消化道出血影响因素分析

Influencing factors of upper gastrointestinal bleeding in coronary heart disease patients treated with double antiplatelet therapy

  • 摘要: 目的 探讨冠心病患者双联抗血小板治疗过程中上消化道出血的发生率及影响因素分析。 方法 回顾性分析100例冠心病患者的临床资料,按用药方案分为对照组和研究组。对照组采用阿司匹林治疗,研究组采用阿司匹林联合硫酸氢氯吡格雷治疗。对比2组患者上消化道出血的发生率和治疗前后凝血指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]水平、血小板凝聚率,并分析上消化道出血的影响因素。 结果 研究组上消化道出血发生率为34.29%, 高于对照组的12.31%,差异有统计学意义(P<0.05); 治疗前, 2组PT、APTT指标水平及血小板凝聚率比较,差异无统计学意义(P>0.05); 治疗后,研究组PT、APTT指标水平高于对照组,血小板凝聚率低于对照组,差异有统计学意义(P<0.05); 年龄≥70岁、胃肠病史、慢性肾功能不全、用药时间>3个月、合并糖尿病、酗酒史是患者发生上消化道出血的重要危险因素。 结论 冠心病患者采用双联抗血小板治疗引发上消化道出血的风险较高,临床用药过程中应加强相关危险因素的防控措施,以降低出血风险,确保用药安全。

     

    Abstract: Objective To investigate the incidence of upper gastrointestinal bleeding in coronary heart disease patients treated with dual antiplatelet therapy, and to analyze its influencing factors. Methods A retrospective analysis was performed to review the clinical materials of 100 patients with coronary heart disease, and were divided into control group and study group according to different medication regimens. The control group was treated with aspirin, and the study group was additionally treated with clopidogrel bisulfate based on the control group. The incidence of upper gastrointestinal bleeding, coagulation indexes[prothrombin time(PT), and activated partial thromboplastin time(APTT)]before and after treatment, and platelet aggregation rate were compared, and the influencing factors of digestive bleeding were analyzed. Results The incidence of upper gastrointestinal hemorrhage in the study group was 34.29%, which was higher than 12.31% in the control group, and the difference was significant(P<0.05); there were no significant differences between the two groups before treatment in PT, APTT and platelet aggregation rate(P>0.05); after treatment, the levels of PT and APTT in the study group were significantly higher than that in the control group, and the platelet aggregation rate was significantly lower than that in the control group(P<0.05). Seventy years of age and above, history of gastrointestinal disease, chronic renal insufficiency, more than 3 months of medication time, history of diabetes and alcoholism were important influencing factors for upper gastrointestinal bleeding(P<0.05). Conclusion The risk of upper gastrointestinal bleeding caused by double antiplatelet therapy in patients with coronary heart disease is high. Therefore, it is necessary to strengthen prevention and control measures during clinical medication to reduce the risk - of bleeding and ensure the safety of medication.

     

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