摘要
目的 探讨抗凝和（或）抗血小板药物治疗时并发消化系统损伤（包括消化道出血等）的相关因素及临床特点.方法 回顾性分析武汉大学人民医院2010年1月1日至2013年12月1日收治的1 443例行抗凝和（或）抗血小板治疗的住院患者的病例特点.观察人口统计学资料、临床特点、治疗与转归情况等,χ^2检验比较组间差异.结果 （1）人口统计学资料：1 443例患者总住院5 ～27 d,以男性（880例,61.0％）、中老年患者（1 240例,85.9％）居多,平均年龄（62±6）岁.1 138例（78.9％）患者职业为农民、工人或无具体职业者.（2）临床特点：抗凝和（或）抗血小板治疗前,既往有无消化系统疾病史本次住院抗凝和（或）抗血小板治疗后新发活动性消化系统损伤的差异有统计学意义[16.0％（41/256）比15.9％（189/1 187）,P=0.01].抗凝和（或）抗血小板治疗同时,有无预防性使用质子泵抑制剂（PPI）短期内并发消化系统损伤（包括消化道出血等）的差异无统计学意义[13.9％（74/533）比17.1％（156/910）,P=2.67].抗凝和（或）抗血小板治疗后,幽门螺杆菌阳性者中并发消化道出血患者比例较高（66.3％,57/86）;并发消化性溃疡和（或）消化性溃疡并出血者185例（12.8％,185/1443;其中十二指肠球部溃疡34例、胃溃疡75例、十二指肠球部溃疡并出血41例、胃溃疡并出血32例、恒径动脉破裂出血3例）,中或重度糜烂性胃炎40例（2.8％,糜烂灶3处以上）,急性胃黏膜病变5例（0.3％）.（3）治疗与转归：76例（5.3％）并发消化道出血;42例（2.9％）行内镜下止血治疗,有效止血（止血治疗后内镜下未见活动性出血情况）40例,手术治疗（胃黏膜修补术及胃大部切除术）2例.死亡97例（6.7％）,其中并发消化道出血死亡者61例（62.9％,61/97）,余均治愈或好转出院.联用三抗（阿司匹林＋氯吡格雷＋华法林）治疗组,联用双抗（阿司匹林＋氯吡格雷）治疗组与单独使用阿司匹林组及单独使用华法林组短期（＜27 d）病死率差异无统计学意义（P=2.29）.结论 对受教育程度不高者（如农民、工人等）,应耐心告知抗凝和（或）抗血小板药物的具体服用方法,密切随诊.老年、男性、既往消化系统疾病史及幽门螺杆菌感染是抗凝和（或）抗血小板药物治疗并发消化系统损伤（包括消化道出血等）的相关危险因素.预防抗凝和（或）抗血小板药物所致消化道损伤,常规剂量PPI的保护作用短期并不显著.患者短期（＜27 d）病死率与抗凝和（或）抗血小板药物剂量及种类无关.
Objective To explore the correlative factors and clinical characteristics of digestive system injury during the treatment of anticoagulant and （or） antiplatelet-agents.Methods A total of 1 443 hospitalized patients on anticoagulant and （or） antiplatelet-agents from January 2010 to December 2013 at Renmin Hospital of Wuhan University were analyzed retrospectively.Results Their length of hospital stay was from 5 to 27 days.Most of them were elderly males （n =880,61.0%） with an average age of（62 ± 6） years.1 138 patients （78.9%） were farmers,workers or someone without a specific occupation.During the treatment of anticoagulant/antiplatelet-agents,statistical difference existed （P =0.01） between positively and negatively previous digestive disease groups for actively newly occurring digestive system injury （16.0%（41/256） vs 15.9% （189/1 187））.After the dosing of anticoagulant and （or） antiplatelet-agents,57（66.3%,57/86） patients were complicated by hemorrhage of digestive tract,taking 62.9% （61/97） of all positive result patients for Helicobacter pylori test.Comparing preventive PPI group with no PPI group,there was no marked statistical differences （P =2.67） for digestive system complication （including hemorrhage of digestive tract） while receiving anticoagulant and （or） antiplatelet-agents （13.9% （74/533） vs 17.1%（156/910））.During anticoagulant and/or antiplatelet-agent therapy,185 patients （12.8%） were complicated by peptic ulcer or peptic ulcer with bleeding,40 patients （2.8%） had erosive gastritis and 5 （0.3%） developed acute gastric mucosal lesions.And 42 of 76 patients complicated by hemorrhage of digestive tract underwent endoscopic hemostasis while 2 patients were operated.Ninety-seven patients （6.7%）died,including 61 （62.9%,61/97） from hemorrhage of digestive tract.The remainder became cured,improved and discharged.Moreover,no significant statistical differences existed （P =2.29） among three combination group （aspirin,clopidogrel,warfarin）,two combination group （aspirin,clopidogrel）,exclusive aspirin group and exclusive warfarin group in short-term （〈 27 d） mortality.Conclusions It is necessary to clearly dictate the details of medication to the patients not highly educated.Elder,male,history of digestive system disease and Helicobacter pylori infection are possibly highly risk correlative factors for digestive system complications during anticoagulant/antiplatelet-agent therapy.The short-term protective effect of routine dose of PPI is inconspicuous.No significant correlation exists between short-term mortality and the dosage （or type） of anticoagulant/antiplatelet-agents.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2014年第20期1553-1558,共6页
National Medical Journal of China
关键词
抗凝药
血小板聚集抑制剂
消化系统疾病
出血
Anticoagulants
Platelet aggregation inhibitors
Digestive system diseases
