质子泵抑制剂联合维生素C预防PCI术后双联抗血小板药物致消化道非活动性出血  

Effect of Proton Pump Inhibitors Combined with Vitamin C on Preventing Non-active Bleeding Caused by Dual Antiplatelet Drugs after PCI Surgery

作　　者：王海霞[1] 赵自冰 牛燕运[1] WANG Hai-xia;ZHAO Zi-bing;NIU Yan-yun(Department of Cardiology,Handan Traditional Chinese Medicine Hospital,Handan 056001,China)

机构地区：[1]河北省邯郸市中医院心血管内科,邯郸056001

出　　处：《微循环学杂志》2024年第2期59-63,共5页Chinese Journal of Microcirculation

摘　　要：目的:探讨质子泵抑制剂(PPI)联合维生素C预防经皮冠状动脉介入(PCI)术后双联抗血小板药物致消化道非活动性出血的效果。方法:采用前瞻性研究,通过随机数字表法将88例PCI术后接受双联抗血小板药物治疗且具有出血风险的患者分为对照组和观察组,各44例。对照组患者给予口服泮托拉唑钠肠溶片,观察组在对照组的治疗基础上加用维生素C注射液静滴。比较两组患者术后3天残余血小板高反应性发生率、术后1个月消化道非活动性出血发生率、治疗前及术后3天应激反应及凝血功能指标的差异。结果:观察组患者术后3天残余血小板高反应性发生率及术后1个月内消化道非活动性出血发生率均低于对照组(均P<0.05)。与治疗前比较,术后3天两组患者血清丙二醛(MDA)水平均降低,观察组更低;两组血清超氧化物歧化酶(SOD)水平均升高,观察组更高(均P<0.05);两组患者血浆凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均缩短,观察组短于对照组;两组血浆纤维蛋白原(FIB)水平均增加,观察组高于对照组(均P<0.05)。两组支架内血栓、心肌梗死、心律失常、心源性猝死等总不良反应发生率无明显差异(P>0.05)。结论:维生素C联合PPI治疗能有效降低PCI后接受双重抗血小板疗法患者的消化道非活动性出血风险。Objective:To explore the effect of proton pump inhibitor(PPI)combined with vitamin C in preventing non-active bleeding after percutaneous coronary intervention(PCI)in patients receiving dual antiplatelet therapy.Method:A prospective study was conducted,and 88 patients who underwent PCI and were at risk of bleeding were randomly divided into a control group and an observation group,with 44 patients in each group.Patients in the control group received oral pantoprazole sodium enteric-coated tablets,while patients in the observation group received oral pantoprazole sodium enteric-coated tablets in combination with vitamin C.The two groups were compared for residual platelet high reactivity rate at 3 days after the procedure,bleeding rate within 1 month after the procedure,severity of gastrointestinal bleeding,stress response before and after treatment,and coagulation function indicators.Results:The observation group had a lower rate of residual platelet high reactivity at 3 days after the procedure and a lower bleeding rate within 1 month after the procedure compared to the control group(both P<0.05).After treatment,both groups showed a decrease in serum malondialdehyde(MDA)levels,with the observation group had lower levels.Both groups showed an increase in serum superoxide dismutase(SOD)levels,with the observation group had higher levels(both P<0.05).Compared to before treatment,both groups had shortened prothrombin time(PT)and activated partial thromboplastin time(APTT),with the observation group had shorter times.Plasma fibrinogen(FIB)levels increased in both groups,with the observation group had higher levels(both P<0.05).There was no significant difference in the overall incidence of adverse reactions such as stent thrombosis,myocardial infarction,arrhythmia,and sudden cardiac death between the two groups(P>0.05).Conclusion:The combination of vitamin C and PPI therapy effectively reduces the risk of non-active bleeding in patients receiving dual antiplatelet therapy after PCI.

关 键 词：经皮冠状动脉介入 双联抗血小板治疗 出血 

分 类 号：R541.4[医药卫生—心血管疾病]