急性冠脉综合征抗栓治疗致出血并发症相关因素分析  

Factor analysis on bleeding complication induced by anticoagulant treatment in patients with acute coronary syndrome

作　　者：徐兵[1] 李泽浦[1] 秦端[1] 高成林[1] 

机构地区：[1]复旦大学附属华山医院宝山分院心内科,上海200431

出　　处：《中国循证心血管医学杂志》2012年第3期218-220,共3页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：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logis-tic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 treat- ment 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 in- cidence 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 muhifactor Logistic regression analysis showed that age, history of mucous or cavity hemor- rhage, BMI, hemoglobin and creatinine clearance rate were main influence factors of bleeding in ACS patients. Conclu- sion 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 fur- ther confirmation.

关 键 词：急性冠脉综合征 出血 预后因素 

分 类 号：R541.4[医药卫生—心血管疾病]