经皮冠状动脉介入治疗后消化道出血的治疗经验  

Clinical Management for In-Hospital Gastrointestinal Bleeding in Patients After Percutaneous Coronary Intervention

作　　者：邱洪[1] 陈珏[1] 杨跃进[1] 胡小莹[1] 宋雷[1] 谭晓燕[1] 张峻[1] 吴元[1] 高润霖[1] 陈在嘉[1] 

机构地区：[1]中国医学科学院北京协和医学院心血管病研究所阜外心血管病医院冠心病诊治中心,北京市100037

出　　处：《中国循环杂志》2013年第4期250-253,共4页Chinese Circulation Journal

摘　　要：目的:总结经皮冠状动脉介入治疗(PCI)后住院期间发生消化道出血的治疗经验。方法:对我院2002-09至2012-07间68例PCI术后住院期间发生消化道出血的患者资料进行回顾性分析,总结PCI术后发生消化道出血的治疗策略。结果:68例患者中,34例(50%)为急性冠状动脉综合征(ACS)患者,27例(40%)为急诊PCI患者。64例(94%)置入药物洗脱支架,4例(6%)置入裸金属支架。PCI术后消化道出血的治疗包括:输血(24例,35.3%),静脉滴注大剂量奥美拉唑(68例,100%),长期停阿司匹林(18例,26.5%),暂停氯吡格雷(14例,20.6%)及应用口服止血药(52例,76.5%)等。住院期间5例(7%)患者因脑卒中和多脏器功能衰竭死亡,无主要不良心血管事件发生。结论:PCI后发生消化道出血时在短期停用阿司匹林、选择性继续服用氯吡格雷的基础上,予禁食、抑酸、补液及胃管内应用云南白药、凝血酶等止血治疗,可有效治疗消化道出血,且可避免主要不良心血管事件的发生。Ohjective： To analyze the clinical management for in-hospital gastrointestinal bleeding （GIB） in patients after percutaneous coronary intervention （PCI）. Methods： We retrospectively analyzed 68 consecutive GIB patients after receiving PCI who were treated in our hospital from September 2002 to July 2012. There 34/68 （50%） patients suffered from acute coronary syndrome, and 27/68 （40%） patients had emergent PCI; 64 （94%） patients received drug eluting stents （DES） and 4 （6%） received bare metal stents （BMS） treatment. Results： The clinical managemefit of post PCI GIB included blond transfusion in 24/68 （35.3%） patients and intravenous infusion of high-dose omeprazole in 68 （100%） patients. There were 18 （26.5%） patients ceased of aspirin and 14 （20.6%） stopped clopidogrel, and 52 （76.5%） patients received oral hemostasis medication. There were 5 （7%） patients died for stroke or multiple organ failure and no one had major adverse cardiac events （MACE） during the in-hospital period. Conclusion： Post GIB could be effectively treated by short term cessation of aspirin, selectively continuing clopidogrel with fasting and hemotasis medication. That management may protect the patients from in-hospital MACE after PCI.

关 键 词：经皮冠状动脉介入治疗 消化道出血 治疗 

分 类 号：R54[医药卫生—心血管疾病]