CAJ | 학술논문

目的：分析不同的抗血小板药物治疗方案对上消化道出血发生率的影响。方法选取第三军医大学新桥医院2013年10月~2015年2月收治的心脑血管疾病合并上消化道出血患者180例作为研究对象，回顾性分析其临床资料，根据其是否曾服用过抗血小板药物将其分为非药物组(对照组，68例)和药物组(观察组，112例)，然后根据其使用的抗血小板药物种类又将观察组分为阿司匹林组(66例)、氯吡格雷组(21例)和联用组(25例)。比较各组患者的各临床指标及其出血情况。结果经过不同的抗血小板治疗后，观察组消化道出血率明显高于对照组，住院时间明显短于对照组，出血前腹痛发生率明显低于对照组，差异均有统计学意义(均P<0.05)。观察组患者的消化道出血方式主要表现为黑便，且内镜下的临床表现为胃溃疡和十二指肠溃疡，但阿司匹林组、氯吡格雷组和联用组在消化道出血方式、出血率及在内镜下的临床表现方面差异均无统计学意义(均P>0.05)。对观察组患者进行单因素分析，消化道出血与年龄及幽门螺杆菌感染相关(P<0.05)，但与性别、服药时间、既往溃疡病史和出血史、脑动脉及冠状动脉支架的置入情况及质子泵抑制剂的使用均无相关性(P>0.05)。对观察组患者进行多因素Logistic回归分析，患者的年龄及幽门螺杆菌感染情况均与消化道出血发生率密切相关(P<0.05)。结论心脑血管疾病患者服用抗血小板类药物可增加上消化道出血发生率，且出血前其腹痛症状较少见，临床上表现为黑便及消化性溃疡。阿司匹林与氯吡格雷单用或者联用对上消化道出血均无明显影响，而年龄及幽门螺杆菌感染情况是其出血发生的主要影响因素。
목적：분석불동적항혈소판약물치료방안대상소화도출혈발생솔적영향。방법선취제삼군의대학신교의원2013년10월~2015년2월수치적심뇌혈관질병합병상소화도출혈환자180례작위연구대상，회고성분석기림상자료，근거기시부증복용과항혈소판약물장기분위비약물조(대조조，68례)화약물조(관찰조，112례)，연후근거기사용적항혈소판약물충류우장관찰조분위아사필림조(66례)、록필격뢰조(21례)화련용조(25례)。비교각조환자적각림상지표급기출혈정황。결과경과불동적항혈소판치료후，관찰조소화도출혈솔명현고우대조조，주원시간명현단우대조조，출혈전복통발생솔명현저우대조조，차이균유통계학의의(균P<0.05)。관찰조환자적소화도출혈방식주요표현위흑편，차내경하적림상표현위위궤양화십이지장궤양，단아사필림조、록필격뢰조화련용조재소화도출혈방식、출혈솔급재내경하적림상표현방면차이균무통계학의의(균P>0.05)。대관찰조환자진행단인소분석，소화도출혈여년령급유문라간균감염상관(P<0.05)，단여성별、복약시간、기왕궤양병사화출혈사、뇌동맥급관상동맥지가적치입정황급질자빙억제제적사용균무상관성(P>0.05)。대관찰조환자진행다인소Logistic회귀분석，환자적년령급유문라간균감염정황균여소화도출혈발생솔밀절상관(P<0.05)。결론심뇌혈관질병환자복용항혈소판류약물가증가상소화도출혈발생솔，차출혈전기복통증상교소견，림상상표현위흑편급소화성궤양。아사필림여록필격뢰단용혹자련용대상소화도출혈균무명현영향，이년령급유문라간균감염정황시기출혈발생적주요영향인소。
Objective To analyze the effect of different anti-platelet therapeutic schedules for incidence of upper gas-trointestinal hemorrhage. Methods 180 patients with cardiovascular and cerebrovascular diseases in combination with upper gastrointestinal hemorrhage admitted to Xinqiao Hospital, Third Military Medical University from October 2013 to February 2015 were selected as research subjects, and the clinical data was analyzed retrospectively. According to whether the patients took the anti-platelets, they were divided into non-drug group (control group, 68 cases) and drug group (observation group, 112 cases), then according to different kinds of anti-platelets, the patients of observation group were divided into Aspirin group (66 cases), Clopidogrel group (21 cases) and combined group (25 cases). The clinical indexes and bleeding conditions of all groups were compared. Results After different therapies of anti-platelets, the rate of gastrointestinal bleeding in observation group was higher than that of control group, the hospital stay was shorter than that of control group, the incidence of stomachache before bleeding was lower than that of control group, the differences were all statistically significant (all P< 0.05). The gastrointestinal hemorrhage way of observation group mainly showed melena, and the clinical manifestation under endoscopic was gastric ulcer and duodenal ulcer, while there were no statistically significant differences in gastrointestinal hemorrhage way, hemorrhagic rate and clinical man-ifestation under endoscopic among Aspirin group, Clopidogrel group and combined group (all P> 0.05). Single factor analysis for observation group showed that, gastrointestinal hemorrhage was related to age and Hp infection (P<0.05), while it had no correlation with sex, time of taking medicine, previous ulcer history and hemorrhage history, cerebral and coronary stent placement conditions and use of proton pump inhibitor (P> 0.05). Multivariate Logistic regression analysis for observation group showed that, the age and Hp infection had close correlation with gastrointestinal hemorrhage (P<0.05). Conclusion The patients with cardio-vascular and cerebrovascular diseases taking anti-platelet drugs can increase the rate of upper gastrointestinal hemor-rhage, and the abdominal pain is less, which shows melena and peptic ulcer in clinic. The single use of Aspirin and Clopidogrel or combined use has no obvious influence on upper gastrointestinal hemorrhage, while the age and Hp in-fection are the main influencing factors of gastrointestinal hemorrhage.