非静脉曲张上消化道出血患者使用阿司匹林作为一级预防药物的保护作用  

The use of aspirin for primary prophylaxis in patients with non-variceal upper gastrointestinal bleeding may be more benefit

作　　者：任吉霞 肖紫英 李圣惠 鹿艳 李效银 Ren Jixia;Xiao Ziying;Li Shenghui;Lu Yah;Li Xiaoyin(Department of Pharmacy, 89th Hospital of PLA, Weifang 261021, China)

机构地区：[1]解放军第八九医院药剂科,山东省潍坊261021

出　　处：《中国医师杂志》2018年第6期874-878,共5页Journal of Chinese Physician

摘　　要：目的比较服用和未服用阿司匹林进行心血管意外一级预防的非静脉曲张上消化道出血(NVUGIB)患者的结局。方法本研究纳入本院2006年至2016年间收治的未罹患任何心血管疾病(包括冠心病和脑血管病)的NVUGIB的入院患者。对比服用阿司匹林的患者和未使用抗血栓药物的患者的住院死亡率、再出血比例、严重出血比例、需要手术或栓塞治疗的患者比例以及上述4种出血相关不良结局的复合结局的发生比例。同时比较服用和不服用阿司匹林患者的住院并发症比例和住院时间。结果共有179例NVUGIB患者符合入组条件,其中服用阿司匹林者47例(阿司匹林组),未使用任何抗血栓药者132例(对照组)。阿司匹林组患者的年龄大于对照组[(66. 8±13.1)岁vs (58.4±19.1)岁,P<0.01],患糖尿病[25.5%(12/47) vs 12.1%(16/132)]、高血压[46. 8%(22/47) vs 28. 0%(37/132)]、血脂异常[21. 3%(10/47) vs 6. 1%(8/132)]的比率高于对照组(均P <0. 01),吸烟的比率亦高于对照组[36. 2%(17/47) vs 22.7%(30/132),P <0. 05]。两组患者需要内窥镜治疗和手术的比例相当,同时两组患者的住院并发症和再出血的比例相近,差异均无统计学意义(P>0. 05)。阿司匹林组患者的住院死亡率比对照组更低[2.1%(1/47) vs 13.6%(18/132), P<0.01],住院时间更短[(4.9±3.5)d vs (7.0±10.3) d,P <0.05],复合结局的发生率更低[10. 6%(5/47) vs 24. 2%(32/132),P <0. 05]。结论 NVUGIB患者在服用适当的阿司匹林进行心血管病意外的一级预防之后,其不良结局的发生率明显降低。因此,对于NVUGIB患者而言,阿司匹林可能具有超出其心血管保护作用的额外功效。Objective To compare the outcomes of patients with non-variceal upper gastrointestinal bleeding （NVUGIB） taking aspirin for primary prophylaxis to those not taking it. Methods Patients without any vascular disease （ coronary artery or cerebrovascular disease） who were admitted to the 89th Hospital of PLA between 2006 and 2016 with non-variceal upper gastrointestinal bleeding were included. The frequencies of in-hospital mortality, re-bleeding, severe bleeding, need for surgery or embolization, and of a composite outcome of the 4 bleeding related adverse outcomes were compared between patients receiving as- pirin and those on no antithrombotics. We also compared the frequency of in hospital complications and length of hospital stay between the two groups. Results Of the 179 eligible patients, 47 were on aspirin and 132 patients were on no antithrombotics （control group）. Patients in the aspirin group （58.4 years） were elder than that in controls （66. 8 years） （P 〈0. 01 ）. Patients in the aspirin group had significantly more co-morbidities, including diabetes mellitus [25.5% （12/47） vs 12. 1% （16/132） ] and hypertension [46.8% （22/47） vs 28.0% （37/t32） ], respectively, as well as dyslipidemia [21.3% （10/47） vs 6. 1% （8/132） 1 （P 〈 0. 01 ）. Smoking was more frequent in the aspirin group [ 36. 2% （17/47） vs 22. 7% （ 30/ 132 ） , P 〈 0. 05 ]. The frequencies of endoscopic therapy and surgery were similar in both groups, while the frequencies of in-hospital complications and re-bleeding were similar in the two groups, too. However, the patients who were on aspirin had lower in hospital mortality rates （2. 1% vs 13.6% ,P 〈0. 01 ） , shorter hospital stay （4. 9 d vs 7. 0 d, P 〈0.05）, and fewer composite outcomes （ 10. 6% vs 24. 2%, P 〈0. 05）. Conclusions Patients who present with NVUGIB while receiving aspirin for primary prophylaxis had fewer adverse outcomes. Thus aspirin may have a protective effect beyond its cardiovascular benefits.

关 键 词：胃肠出血 阿司匹林 发病率 死亡率 

分 类 号：R573.2[医药卫生—消化系统]