PCI围术期消化道出血患者抗血小板治疗调整及近期疗效  

Effects of anti-platelet drugs adjustment on patients with gastrointestinal bleeding undergoing percutaneous coronary intervention

作　　者：陶杰[1] 韩雅玲[1] 王效增[1] 荆全民[1] 王守力[1] 马颖艳[1] 王耿[1] 栾波[1] 王斌[1] 

机构地区：[1]沈阳军区总医院心内科,辽宁沈阳110840

出　　处：《现代生物医学进展》2010年第24期4690-4692,4695,共4页Progress in Modern Biomedicine

摘　　要：目的:探讨经皮冠状动脉介入治疗(PCI)围术期发生消化道出血(GIB)患者抗血小板治疗的调整,评价其安全性及近期疗效。方法:回顾性分析2005年1月至2008年12月PCI围术期发生GIB的40例患者的临床资料,其中急性心肌梗死(AMI)22例(55%),不稳定型心绞痛18例(45%)。PCI围术期发生GIB的患者,除扩容、输血、抑酸、保护胃粘膜等支持疗法外,依据临床情况调整抗血小板药物。观察住院期间及术后3个月后主要不良心脑事件(MACCE:包括心绞痛、非致死性心肌梗死、心性死亡、再次血管重建、支架内血栓形成、缺血性卒中)及消化道再次出血的发生率。结果:40例患者PCI成功39例(病例成功率97.5%),1例慢性完全闭塞(CTO)病变导丝未通过,1例(2.5%)AMI患者PCI术后第5天发生支架内亚急性血栓(SAT)。出院后3月内,2例未完全血运重建的患者有心绞痛发作,无死亡,所有患者均无消化道再次出血,MACCE发生率(7.5%)。结论:PCI围术期发生GIB的患者,依据临床情况调整抗血小板药物,不增加MACCE风险及消化道再次出血发生率。Objective： To explore the adjustment of anti-platelet drugs in patients who underwent gastrointestinal bleeding（GIB） during percutaneous coronary intervention（PCI） perioperative period,and evaluate its short-term efficacy and safety.Methods： The clini-cal data of 40 patients who suffered GIB during PCI perioperative period admitted during January 2005 to December 2008 were retro-spectively analyzed.22（55 %） was diagnosed as acute myocardial infarction and 18（45 %） as unstable angina pectoris.Anti-platelet drugs were adjusted according to patients＇ condition besides treatments such as fluid expansion,blood transfusion and protecting gastric mu-cosa.The data of the incidence of major adverse cardiac and cerebral events（MACCE,including angina pectoris,non-fatal myocardial infarction,cardiac death,revascularization,in-stent thrombosis and stroke） and gastrointestinal re-bleeding events during hospital period and 3 months after discharge were analyzed.Results： One patient failed to achieve revascularization because the guide wire couldn＇t pass through the CTO lesion,the remaining 39 cases gained successful revascularization.The achievement ratio was 97.5 %.Subacute in-stent thrombosis happened to a AMI patient in five days of the first PCI.Within 3 months after discharge,angina pectoris happened to 2 patients who were partially revascularization.No patient died.No gastrointestinal re-bleeding happened.The incidence of MACCE was 7.5 %.Conclusions： For those who underwent GIB circa PCI,the adjustment of anti-platelet drugs according to patients＇ condition can＇t increase the risk of MACCE or incidence of gastrointestinal re-bleeding in short time.

关 键 词：冠状动脉疾病 经皮冠状动脉内成形术 消化道出血 血小板聚集抑制剂 

分 类 号：R541.4[医药卫生—心血管疾病]