中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
20期
1553-1558
,共6页
抗凝药%血小板聚集抑制剂%消化系统疾病%出血
抗凝藥%血小闆聚集抑製劑%消化繫統疾病%齣血
항응약%혈소판취집억제제%소화계통질병%출혈
Anticoagulants%Platelet aggregation inhibitors%Digestive system diseases%Hemorrhage
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,x2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.
目的 探討抗凝和(或)抗血小闆藥物治療時併髮消化繫統損傷(包括消化道齣血等)的相關因素及臨床特點.方法 迴顧性分析武漢大學人民醫院2010年1月1日至2013年12月1日收治的1 443例行抗凝和(或)抗血小闆治療的住院患者的病例特點.觀察人口統計學資料、臨床特點、治療與轉歸情況等,x2檢驗比較組間差異.結果 (1)人口統計學資料:1 443例患者總住院5 ～27 d,以男性(880例,61.0％)、中老年患者(1 240例,85.9％)居多,平均年齡(62±6)歲.1 138例(78.9％)患者職業為農民、工人或無具體職業者.(2)臨床特點:抗凝和(或)抗血小闆治療前,既往有無消化繫統疾病史本次住院抗凝和(或)抗血小闆治療後新髮活動性消化繫統損傷的差異有統計學意義[16.0％(41/256)比15.9％(189/1 187),P=0.01].抗凝和(或)抗血小闆治療同時,有無預防性使用質子泵抑製劑(PPI)短期內併髮消化繫統損傷(包括消化道齣血等)的差異無統計學意義[13.9％(74/533)比17.1％(156/910),P=2.67].抗凝和(或)抗血小闆治療後,幽門螺桿菌暘性者中併髮消化道齣血患者比例較高(66.3％,57/86);併髮消化性潰瘍和(或)消化性潰瘍併齣血者185例(12.8％,185/1443;其中十二指腸毬部潰瘍34例、胃潰瘍75例、十二指腸毬部潰瘍併齣血41例、胃潰瘍併齣血32例、恆徑動脈破裂齣血3例),中或重度糜爛性胃炎40例(2.8％,糜爛竈3處以上),急性胃黏膜病變5例(0.3％).(3)治療與轉歸:76例(5.3％)併髮消化道齣血;42例(2.9％)行內鏡下止血治療,有效止血(止血治療後內鏡下未見活動性齣血情況)40例,手術治療(胃黏膜脩補術及胃大部切除術)2例.死亡97例(6.7％),其中併髮消化道齣血死亡者61例(62.9％,61/97),餘均治愈或好轉齣院.聯用三抗(阿司匹林+氯吡格雷+華法林)治療組,聯用雙抗(阿司匹林+氯吡格雷)治療組與單獨使用阿司匹林組及單獨使用華法林組短期(＜27 d)病死率差異無統計學意義(P=2.29).結論 對受教育程度不高者(如農民、工人等),應耐心告知抗凝和(或)抗血小闆藥物的具體服用方法,密切隨診.老年、男性、既往消化繫統疾病史及幽門螺桿菌感染是抗凝和(或)抗血小闆藥物治療併髮消化繫統損傷(包括消化道齣血等)的相關危險因素.預防抗凝和(或)抗血小闆藥物所緻消化道損傷,常規劑量PPI的保護作用短期併不顯著.患者短期(＜27 d)病死率與抗凝和(或)抗血小闆藥物劑量及種類無關.
목적 탐토항응화(혹)항혈소판약물치료시병발소화계통손상(포괄소화도출혈등)적상관인소급림상특점.방법 회고성분석무한대학인민의원2010년1월1일지2013년12월1일수치적1 443례행항응화(혹)항혈소판치료적주원환자적병례특점.관찰인구통계학자료、림상특점、치료여전귀정황등,x2검험비교조간차이.결과 (1)인구통계학자료:1 443례환자총주원5 ～27 d,이남성(880례,61.0％)、중노년환자(1 240례,85.9％)거다,평균년령(62±6)세.1 138례(78.9％)환자직업위농민、공인혹무구체직업자.(2)림상특점:항응화(혹)항혈소판치료전,기왕유무소화계통질병사본차주원항응화(혹)항혈소판치료후신발활동성소화계통손상적차이유통계학의의[16.0％(41/256)비15.9％(189/1 187),P=0.01].항응화(혹)항혈소판치료동시,유무예방성사용질자빙억제제(PPI)단기내병발소화계통손상(포괄소화도출혈등)적차이무통계학의의[13.9％(74/533)비17.1％(156/910),P=2.67].항응화(혹)항혈소판치료후,유문라간균양성자중병발소화도출혈환자비례교고(66.3％,57/86);병발소화성궤양화(혹)소화성궤양병출혈자185례(12.8％,185/1443;기중십이지장구부궤양34례、위궤양75례、십이지장구부궤양병출혈41례、위궤양병출혈32례、항경동맥파렬출혈3례),중혹중도미란성위염40례(2.8％,미란조3처이상),급성위점막병변5례(0.3％).(3)치료여전귀:76례(5.3％)병발소화도출혈;42례(2.9％)행내경하지혈치료,유효지혈(지혈치료후내경하미견활동성출혈정황)40례,수술치료(위점막수보술급위대부절제술)2례.사망97례(6.7％),기중병발소화도출혈사망자61례(62.9％,61/97),여균치유혹호전출원.련용삼항(아사필림+록필격뢰+화법림)치료조,련용쌍항(아사필림+록필격뢰)치료조여단독사용아사필림조급단독사용화법림조단기(＜27 d)병사솔차이무통계학의의(P=2.29).결론 대수교육정도불고자(여농민、공인등),응내심고지항응화(혹)항혈소판약물적구체복용방법,밀절수진.노년、남성、기왕소화계통질병사급유문라간균감염시항응화(혹)항혈소판약물치료병발소화계통손상(포괄소화도출혈등)적상관위험인소.예방항응화(혹)항혈소판약물소치소화도손상,상규제량PPI적보호작용단기병불현저.환자단기(＜27 d)병사솔여항응화(혹)항혈소판약물제량급충류무관.
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.
