长期口服雷贝拉唑对冠心病PCI术后双联抗血小板疗效的影响  

Impact of Long-Term Oral Rabeprazole Treatment on Dual Antiplatelet Therapy in Cases with Coronary Heart Disease after Percutaneous Coronary Intervention

作　　者：简新闻 樊泽元[1] 季汉华[1] 李莉[1] Jian Xinwen;Fan Zeyuan;Ji Hanhua;Li Li(Department of Cardiology,Peking University Civil Aviation General Hospital,Beijing,100123,P.R.China)

机构地区：[1]北京大学民航总医院心内科

出　　处：《西南军医》2019年第6期501-504,共4页Journal of Military Surgeon in Southwest China

摘　　要：目的评价长期口服雷贝拉唑对冠心病合并消化道出血高风险PCI术后患者双联抗血小板药物疗效的影响及其临床意义。方法入选2015年1月至2016年11月择期行经皮冠状动脉介入治疗(PCI)的患者189例,分为实验组64例,给予口服阿司匹林+氯吡格雷+雷贝拉唑治疗治疗;对照组125例,给予口服阿司匹林+氯吡格雷。检测所有患者术后5天血栓弹力图中二磷酸腺苷(ADP)和花生四烯酸(AA)途径诱导的血小板抑制率,并对两组进行比较,同时比较1年后实验组二磷酸腺苷(ADP)和花生四烯酸(AA)途径诱导的血小板抑制率。同时对比两组患者术后1年内发生主要不良心血管事件(MACE),包括不稳定型心绞痛、非致死性心肌梗死、靶血管血运重建和心脏性死亡;同时观察消化道出血发生情况。结果两组患者临床相关资料及随访MACE事件和消化道出血情况相比无统计学差异(P>0.05);两组患者血小板AA途径和ADP途径抑制率差异均无统计学意义(P>0.05),实验组1年后AA途径和ADP途径抑制率和术后5天相比差异无统计学意义(P>0.05)。结论长期口服雷贝拉唑对合并消化道出血高风险冠心病患者PCI术后常规双联抗血小板治疗是安全有效。Objective To evaluate the impact of long-term oral rabeprazole treatment on dual antiplatelet therapy(DAPT) in cases with coronary heart disease(CHD) after percutaneous coronary intervention(PCI) and to discuss the clinical significance.Methods 189 CHD cases undergoing PCI during the period from January,2015 to November,2016 were divided into 2 groups:treatment group(n=64) and control group(n=125);oral administration of aspirin and clopidogrel was made to cases in both groups while oral administration of rabeprazole was added to cases in treatment group;the levels of platelet inhibition induced by adenosine diphosphate(ADP) and arachidonic acid(AA)in thrombelastograms of all the cases 5 days after PCI were detected and comparative study was made between the 2 groups;the level of ADP and AA in treatment group 5 days after PCI were compared with those 1 year after PCI;a comparative study was conducted on the incidence of major adverse cardiovascular events(MACE),including unstable angina,non-fatal myocardial infarction,target vessel revascularizition and cardiac death,and the gastrointestinal bleeding in the 2 groups was observed.Results There were no statistical differences in the incidence of MACE,gastrointestinal bleeding and platelet inhibition between the 2 groups(all P>0.05);the levels of ADP-induced and AA-induced platelet inhibition in treatment group 5 days after PCI was of no statistical difference from that 1 year after PCI(P>0.05).Conclusions Long-term oral rebeprazole administration is safe and effective in DAPT therapy after PCI in CHD cases with a high risk of gastrointestinal bleeding.

关 键 词：血栓弹力图 血小板抑制率 冠心病 PCI 雷贝拉唑 

分 类 号：R541.4[医药卫生—心血管疾病]