冠脉介入术患者经双联抗血小板治疗发生消化道出血返院治疗的临床特点

被引：9

作者：

王玲 ^{[1
,2
]}

李威 ^{[1
,2
]}

罗建方 ^{[1
,2
]}

罗淞元 ^{[1
,2
]}

陈纪言 ^{[1
,2
]}

机构：

[1] 广东省人民医院心内科

[2] 广东省医学科学院广东省心血管病研究所

来源：

循证医学 | 2015年 / 15卷 / 04期

基金：

广东省科技计划;

关键词：

经皮冠状动脉介入术; 双联抗血小板治疗; 消化道出血;

D O I：

暂无

中图分类号：

R541.4 [冠状动脉（粥样）硬化性心脏病（冠心病）]; R57 [消化系及腹部疾病];

学科分类号：

摘要：

目的探讨经皮冠脉介入术患者使用双联抗血小板治疗后因消化道出血返院诊治的临床特点。方法选取2011-2013年在广东省人民医院心内科行冠脉介入术长期双联抗血小板治疗后再次住院的患者2 675例,收集了其中28例疑似消化道出血患者的临床资料,对于其中21例确诊为消化道出血的患者使用CRUSADE出血评分系统进行出血风险危险分层,分析该21例患者消化道出血诊治的相关临床特点。结果 21例确诊消化道出血患者中,高龄患者(>60岁)14例(66.7%),男性16例(76.2%),吸烟史患者5例(23.8%),消化性溃疡病史5例(23.8%),消化道出血病史2例(9.5%),肾功能不全病史17例(81%),心功能衰竭病史18例(85.7%),幽门螺杆菌感染7例(33.3%)。使用CRUSADE出血评分系统进行出血风险评分并行危险分层,其中出血风险极高危者7例(33.3%),高危者5例(23.8%),中危者6例(28.6%)。消化道出血前曾预防性口服质子泵抑制剂6例,消化道出血后所有患者均使用质子泵抑制剂治疗。本组患者有一半以上(61.9%)在消化道出血后停用了所有抗血小板治疗药物,消化道出血控制后,约一半(52.4%)患者使用氯吡格雷继续抗血小板治疗。结论 CRUSADE评分系统可以用于经皮冠脉介入术后双联抗血小板治疗患者消化道出血风险的早期评估。抗血小板药物的停用与重新使用应根据消化道出血的严重程度、支架血栓形成的风险等综合评估。

引用

页码：242 / 246+251 +251

页数：6

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