雷贝拉唑和替普瑞酮治疗双联抗血小板所致上消化道出血的对比研究  

Rabeprazole and teprenone in treatment of upper gastrointestinal bleeding induced by dual antiplatelet agents:a comparative study

作　　者：尹春梅[1] 孙瑶 苏亚荣 康璇[1] 王雅靖 李瑛[3] 苏敏娜 贾子玉 常佩 柴婵娟[2] Yin Chunmei;Sun Yao;Su Yarong;Kang Xuan;Wang Yajing;Li Ying;Su Minna;Jia Ziyu;Chang Pei;Chai Chanjuan(Department of Gastroenterology,Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院消化内科,太原030001 [2]山西医科大学第二医院心内科,太原030001 [3]山西医科大学

出　　处：《中国药物与临床》2021年第2期189-192,共4页Chinese Remedies & Clinics

基　　金：山西省研究生教育改革研究课题(2020YJJG128)

摘　　要：目的探讨质子泵抑制剂(PPI)雷贝拉唑和胃黏膜保护剂替普瑞酮对经皮冠状动脉介入(PCI)术后服用双联抗血小板药物患者上消化道出血的预防效果。方法400例PCI术后服用肠溶阿司匹林合并氯吡格雷纳入本研究,按治疗小组分为4组:常规治疗组100例、PPI组100例、胃黏膜保护剂组100例、PPI+胃黏膜保护剂组100例。随访6个月,观察患者的上消化道出血发生率及严重程度、主要心脏不良事件(MACE)、不良反应等。结果4组中6个月内发生上消化道出血28例,其中常规治疗组15例(大出血2例,小出血4例,轻微出血9例),PPI组3例(轻微出血),胃黏膜保护剂组9例(小出血3例,轻微出血6例),PPI+胃黏膜保护剂组1例(轻微出血),4组6个月内上消化道出血发生率差异有统计学意义(χ2=18.43,P<0.01),其中常规治疗组明显高于PPI组和PPI+胃黏膜保护剂组(P<0.05),其他各组间消化道出血发生率差异无统计学意义(P>0.05)。术后3个月内发生上消化道出血27例,占全部上消化道出血96%。4组MACE发生差异无统计学意义(χ2=4.05,P=0.262)。结论雷贝拉唑或雷贝拉唑联合替普瑞酮口服可降低PCI术后双联抗血小板药物患者上消化道出血的发生率。上消化道出血的预防性治疗应从PCI术后第1天开始,至少维持3~6个月,甚至更长。Objective To investigate the effect of rabeprazole(proton pump inhibitor,PPI)and teprenone(gastric mucosa protectant)on the prevention of upper gastrointestinal bleeding in patientsreceived dual anti-platelet therapyafter post-percutaneous coronary intervention(PCI).Methods A total of 400 patients taking enteric Aspirin and Clopidogrel after PCI were included in the study.According to the treatment methods,all patients were divided into the routine treatment group,PPI group,gastric mucosa protectant group,and PPI+gastric mucosa protectant group(n=100 each).Followed up for 6 months,theincidence and severity of upper gastrointestinal bleeding,major adverse cardiac events(MACE)and adverse reactions were determined.Results There were 28 cases of 6-month upper gastrointestinal bleeding in the 4 groups,including 15 in the routine treatment group(2 of massive bleeding,4 of moderate bleeding and 9 of mild bleeding),3 in the PPI group(mild bleeding),9 in the gastric mucosa protectant group(3 of moderate bleeding and 6 of mild bleeding)and 1 in the PPI+gastric mucosa protectant group(mild bleeding).There was statistically significant difference in the incidence of upper gastrointestinal bleeding among the 4 groups within 6 months(χ2=18.43,P<0.01).The incidence of upper gastrointestinal bleeding in the routine treatment group was significant higher than that in the PPI group and gastric mucosa protectant group(P<0.05),whereas there was no statistical difference in the incidence among the other groups(P>0.05).There were 27 cases of 3-month upper gastrointestinal bleeding after the operation,accounting for 96%of all upper gastrointestinal bleeding.There was no statistically significant difference in the incidence of cardiovascular events among the 4 groups(χ2=4.05,P=0.262).Conclusion Oral Rabeprazole or rabeprazole combined with teprenone may reduce the incidence of upper gastrointestinal bleeding in patients received dual anti-platelet therapy after PCI.Prevention against upper gastrointestinal bleeding should start on the

关 键 词：质子泵抑制剂 胃黏膜保护剂 阿司匹林 氯吡格雷 出血 上消化道 

分 类 号：R573.2[医药卫生—消化系统]