摘要
目的评价CRUSADE评分系统对急性冠脉综合征(ACS)患者抗血小板治疗的出血风险进行评估的准确性及高出血风险患者应用PPIs的临床价值。方法选取自2010年6月-2013年6月于医院心内科并急诊病房住院的ACS病例572例,按照CRUSADE评分对这些患者进行危险分层,并将其中的高危出血组随机分为PPIs治疗组及对照组。所有患者均服用双重抗血小板药物(阿司匹林与氯吡格雷联用)1年,随访观察期间的消化道出血发生率及主要、次要心血管不良事件并进行统计分析。结果 CRUSADE评分高危组相较于低中危组消化道出血发生率明显增高;而高危出血风险组加用PPIs的后的消化道出血发生率明显下降,差异有统计学意义;而主要及次要心血管事件发生率虽有所增高,但差异不具有统计学意义。结论 CRUSADE评分系统对于ACS患者双联抗血小板治疗的出血风险有良好的评估价值。对高出血风险患者加用质子泵抑制剂能够有效减少消化道出血的发生率,且心血管不良事件发生率的无显著增加。
Objective To evaluate the application of CRUSADE scoring system in prediction of hemorrhage in pa- tientswith acute coronary syndromes （ ACS ） and the clinical value of PPIs in patients with high bleeding risk. Methods To se- lect572 cases of ACS of ACS from Cardiology and emergency ward in hospital since 2010 June to 2013 June,andto valuatethe risk stratification of these patients according to CRUSADE score system. Then the high risk of bleeding were randomly divided into PPIs group and control group. All the patients were taking dual antiplatelet drugs （aspirin and clopidogrel ） for 1 year,then to Follow up the incidence of gastrointestinal bleeding, minor and major adverse cardiovascular events. Results Compared with the low risk group of CRUSADE score, the incidence of gastrointestinal bleeding of high-risk group were markedly increased. And the incidence of digestive hemorrhage were decreasedin the high risk group with PPIs, and the difference was statistically significant. Although the incidence of major and minor cardiovascular events was increased, but the difference was not statisti- cally significant. Conclusion The CRUSADE scoring system is good for the risk assessment of bleedingin ACS patients with dual antiplatelet therapy. Combined with a proton pump inhibitor can effectively reduce the rate of digestive tract hemorrhage in patients of high-risk. And the incidence of cardiovascular adverse events is not significant increased.
出处
《临床合理用药杂志》
2015年第26期6-7,13,共3页
Chinese Journal of Clinical Rational Drug Use
