双抗药物对消化道黏膜的损害与内镜诊治  

Damage of dual antiplatelet drug to gastrointestinal mucosa and endoscopic diagnosis and treatment

作　　者：郝璐[1] 胡良皞[1] 李兆申[1] HAO Lu;HU Lianggao;LI Zhao-shen(Department of Gastroenterology,Changhai Hospital,the Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学长海医院消化内科,上海200433

出　　处：《中国实用内科杂志》2019年第3期245-248,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81770635;81470883;81770632;81600439;81500490);上海青年医生培养计划(AB830-30002015034);上海市青年科技启明星计划(17QA1405500);上海青年拔尖人才计划(HZW2016FZ67)

摘　　要：抗血小板药物在血管栓塞性疾病一级和二级预防中的应用广泛,可减少心脑血管不良事件的发生。但双联抗血小板药物在抑制血小板聚集的同时,也会影响消化道黏膜的修复与愈合,导致溃疡形成和出血,严重时可致患者死亡。联合用药时消化道大出血的风险明显增加。对于双抗药物导致的消化道出血患者,应首选内镜下止血治疗,平衡获益和风险。为预防双抗药物导致的消化道黏膜损伤,应采用标准化流程对患者进行风险评估和筛选,规范抗血小板治疗的适应证;同时早期识别消化道损伤高危人群,采取合理的保护措施,尽可能减少消化道损伤和出血的发生。Antiplatelet drugs are widely used in primary and secondary prevention of vascular embolism diseases,which can reduce the occurrence of cardiovascular and cerebrovascular adverse events.However,while inhibiting platelet aggregation,dual antiplatelet drugs can also affect the repair of gastrointestinal mucosa,leading to gastric ulcer formation and bleeding.More severely,patients may die from hemorrhage.The risk of severe hemorrhage increases significantly following a combination antiplatelet drug regimen.Endoscopic hemostasis should be the first choice for patients with gastrointestinal hemorrhage caused by dual antiplatelet therapy.Benefits and risks should be balanced.In order to prevent gastrointestinal mucosal injury caused by dual antiplatelet therapy,standardized process should be adopted to assess and screen the risk of patients,and the indications of antiplatelet therapy should also be standardized.Meanwhile,high-risk population of gastrointestinal injury should be identified in advance.In order to minimize the occurrence of gastrointestinal injury and bleeding,appropriate protective measures should be taken.

关 键 词：双抗治疗 内镜 消化道黏膜 

分 类 号：R573.2[医药卫生—消化系统]