抗凝或抗血小板药物致消化系统损伤的相关因素分析  

Retrospective analysis of correlative factors between digestive system injury and anticoagulant or antiplatelet-agents

作　　者：崔凝[1] 罗和生[1] 

机构地区：[1]武汉大学人民医院消化内科,430060

出　　处：《中华医学杂志》2014年第20期1553-1558,共6页National Medical Journal of China

摘　　要：目的 探讨抗凝和（或）抗血小板药物治疗时并发消化系统损伤（包括消化道出血等）的相关因素及临床特点.方法 回顾性分析武汉大学人民医院2010年1月1日至2013年12月1日收治的1 443例行抗凝和（或）抗血小板治疗的住院患者的病例特点.观察人口统计学资料、临床特点、治疗与转归情况等,χ^2检验比较组间差异.结果 （1）人口统计学资料：1 443例患者总住院5 ～27 d,以男性（880例,61.0％）、中老年患者（1 240例,85.9％）居多,平均年龄（62±6）岁.1 138例（78.9％）患者职业为农民、工人或无具体职业者.（2）临床特点：抗凝和（或）抗血小板治疗前,既往有无消化系统疾病史本次住院抗凝和（或）抗血小板治疗后新发活动性消化系统损伤的差异有统计学意义[16.0％（41/256）比15.9％（189/1 187）,P=0.01].抗凝和（或）抗血小板治疗同时,有无预防性使用质子泵抑制剂（PPI）短期内并发消化系统损伤（包括消化道出血等）的差异无统计学意义[13.9％（74/533）比17.1％（156/910）,P=2.67].抗凝和（或）抗血小板治疗后,幽门螺杆菌阳性者中并发消化道出血患者比例较高（66.3％,57/86）;并发消化性溃疡和（或）消化性溃疡并出血者185例（12.8％,185/1443;其中十二指肠球部溃疡34例、胃溃疡75例、十二指肠球部溃疡并出血41例、胃溃疡并出血32例、恒径动脉破裂出血3例）,中或重度糜烂性胃炎40例（2.8％,糜烂灶3处以上）,急性胃黏膜病变5例（0.3％）.（3）治疗与转归：76例（5.3％）并发消化道出血;42例（2.9％）行内镜下止血治疗,有效止血（止血治疗后内镜下未见活动性出血情况）40例,手术治疗（胃黏膜修补术及胃大部切除术）2例.死亡97例（6.7％）,其中并发消化道出血死亡者61例（62.9％,61/97）,余均治愈或好转出院.联用三抗（阿司匹林＋氯吡格雷＋华法林）治疗组,联用�Objective To explore the correlative factors and clinical characteristics of digestive system injury during the treatment of anticoagulant and （or） antiplatelet-agents.Methods A total of 1 443 hospitalized patients on anticoagulant and （or） antiplatelet-agents from January 2010 to December 2013 at Renmin Hospital of Wuhan University were analyzed retrospectively.Results Their length of hospital stay was from 5 to 27 days.Most of them were elderly males （n =880,61.0%） with an average age of（62 ± 6） years.1 138 patients （78.9%） were farmers,workers or someone without a specific occupation.During the treatment of anticoagulant/antiplatelet-agents,statistical difference existed （P =0.01） between positively and negatively previous digestive disease groups for actively newly occurring digestive system injury （16.0%（41/256） vs 15.9% （189/1 187））.After the dosing of anticoagulant and （or） antiplatelet-agents,57（66.3%,57/86） patients were complicated by hemorrhage of digestive tract,taking 62.9% （61/97） of all positive result patients for Helicobacter pylori test.Comparing preventive PPI group with no PPI group,there was no marked statistical differences （P =2.67） for digestive system complication （including hemorrhage of digestive tract） while receiving anticoagulant and （or） antiplatelet-agents （13.9% （74/533） vs 17.1%（156/910））.During anticoagulant and/or antiplatelet-agent therapy,185 patients （12.8%） were complicated by peptic ulcer or peptic ulcer with bleeding,40 patients （2.8%） had erosive gastritis and 5 （0.3%） developed acute gastric mucosal lesions.And 42 of 76 patients complicated by hemorrhage of digestive tract underwent endoscopic hemostasis while 2 patients were operated.Ninety-seven patients （6.7%）died,including 61 （62.9%,61/97） from hemorrhage of digestive tract.The remainder became cured,improved and discharged.Moreover,no significant statistical differences existed （P =2.29） among three combination group �

关 键 词：抗凝药 血小板聚集抑制剂 消化系统疾病 出血 

分 类 号：R595.3[医药卫生—内科学]