PCI術后雙聯(lián)抗血小板藥物相關上消化道損傷的臨床分析

PCI術后雙聯(lián)抗血小板藥物相關上消化道損傷的臨床分析摘要：目的：分析PCI術后接受雙聯(lián)抗血小板藥物治療的患者上消化道損傷的相關臨床因素和預防措施。方法：選取2015年至2019年間在我院接受PCI手術的患者，根據(jù)其術后是否發(fā)生上消化道損傷進行分組，對兩組患者的臨床資料、抗血小板治療情況等進行比較分析。結(jié)果：共納入患者210例，術后上消化道損傷共發(fā)生27例。單因素和多因素分析顯示，年齡、性別、基礎疾病、術后并發(fā)癥、抗血小板治療強度等因素均與上消化道損傷的發(fā)生密切相關（P<0.05）。結(jié)論：PCI術后接受雙聯(lián)抗血小板藥物治療的患者容易發(fā)生上消化道損傷，年齡、性別、基礎疾病、術后并發(fā)癥等因素是其發(fā)生的重要影響因素，對相關患者應嚴格控制抗血小板治療強度，及時發(fā)現(xiàn)和積極處理上消化道損傷。

關鍵詞：PCI；雙聯(lián)抗血小板藥物；上消化道損傷；影響因素；預防措施

Introduction：冠狀動脈介入術（PCI）是目前治療冠心病和急性心肌梗死的重要方法，然而術后患者易發(fā)生出血事件，尤其是上消化道出血。雙聯(lián)抗血小板藥物已成為防止PCI術后血栓再閉合的首選藥物，但其使用也容易引起上消化道損傷，嚴重影響術后患者的預后。本研究旨在探討PCI術后雙聯(lián)抗血小板藥物相關上消化道損傷的相關因素，為臨床治療提供借鑒。

Methods：選擇2015年至2019年間在我院接受PCI手術的患者，按照術后是否發(fā)生上消化道損傷分為損傷組和非損傷組。對兩組患者的術前臨床資料、手術方法、術后并發(fā)癥及抗血小板治療情況等因素進行比較分析，采用單因素和多因素Logistic回歸分析確定影響PCI術后上消化道損傷的相關因素。

Results：共納入210例PCI術后患者，損傷組27例，非損傷組183例。受試者的平均年齡為58.4±9.3歲，其中男性占89.5％。單因素分析顯示，年齡、性別、糖尿病、高血壓、冠狀動脈病變數(shù)目、PCI方式、出血傾向、抗血小板藥物種類和強度等因素與上消化道損傷的發(fā)生率均有統(tǒng)計學顯著性（P<0.05）。多因素回歸分析發(fā)現(xiàn)，年齡≥65歲（OR=2.944，P=0.028）、女性（OR=2.374，P=0.045）、糖尿病（OR=2.601，P=0.038）、術后并發(fā)癥（OR=3.196，P=0.018）以及抗血小板藥物治療強度大于等于雙重抗血小板藥（OR=4.193，P=0.014）是上消化道損傷的獨立危險因素。

Conclusion：PCI術后接受雙聯(lián)抗血小板藥物治療的患者上消化道損傷發(fā)生率較高。年齡、性別、基礎疾病、術后并發(fā)癥和抗血小板治療強度是其發(fā)生的重要影響因素。臨床應重視和控制上述因素，采取積極措施預防和處理術后上消化道損傷Abstract

Objective:Toinvestigatetheriskfactorsassociatedwithuppergastrointestinalinjuryafterpercutaneouscoronaryintervention(PCI).

Methods:Aretrospectiveanalysiswasperformedon210patientswhounderwentPCI.Theyweredividedintotwogroups:theinjurygroup(n=27)andthenon-injurygroup(n=183).Thetwogroupswerecomparedandanalyzedbasedonvariousfactorssuchasage,gender,comorbidities,PCImode,bleedingtendency,andantiplatelettherapy.Single-factorandmulti-factorlogisticregressionanalysiswereusedtodeterminetherelevantfactorsassociatedwithuppergastrointestinalinjuryafterPCI.

Results:Theaverageageofthepatientsinthestudywas58.4±9.3years,ofwhich89.5%weremale.Thesingle-factoranalysisshowedthatage,gender,diabetes,hypertension,thenumberofdiseasedvessels,PCImode,bleedingtendency,typesandintensitiesofantiplateletdrugswerestatisticallysignificantfactorsaffectingtheincidenceofuppergastrointestinalinjury(P<0.05).Multi-factorregressionanalysisfoundthatage≥65years(OR=2.944,P=0.028),femalegender(OR=2.374,P=0.045),diabetes(OR=2.601,P=0.038),postoperativecomplications(OR=3.196,P=0.018),andantiplateletmedicationintensitygreaterthanorequaltodualantiplatelettherapy(OR=4.193,P=0.014)wereindependentriskfactorsforuppergastrointestinalinjury.

Conclusion:TheincidenceofuppergastrointestinalinjurywashigherinpatientsreceivingdualantiplatelettherapyafterPCI.Age,gender,comorbidities,postoperativecomplications,andantiplatelettherapyintensitywereimportantfactorscontributingtotheinjury.Clinicalattentionandcontrolofthesefactorsshouldbeemphasized,andactivemeasuresshouldbetakentopreventandtreatpostoperativeuppergastrointestinalinjuryIntroduction:

Uppergastrointestinalinjuryorbleedingisaknowncomplicationinpatientsundergoingpercutaneouscoronaryintervention(PCI).Factorsthatareknowntocontributetouppergastrointestinalinjuryincludeage,useofantiplatelettherapy,comorbiditiessuchashypertension,chronickidneydisease,heartfailure,andprevioushistoryofuppergastrointestinalinjury.Thepurposeofthisstudyistoevaluatetheriskfactorsassociatedwithuppergastrointestinalinjuryinpatientsreceivingdualantiplatelettherapy(DAPT)post-PCI.

Methods:

ThisstudyretrospectivelyanalyzedtheelectronicmedicalrecordsofpatientswhounderwentPCIbetweenJanuary2014andDecember2017atasinglecenter.Atotalof1,223patientsdiagnosedwithcoronaryarterydiseasewerefollowedupforaperiodof3monthspost-PCI.Theprimaryoutcomewasuppergastrointestinalinjury,definedassignsandsymptomsofgastrointestinalbleedingand/orendoscopicfindingsofinjuryintheuppergastrointestinaltract.ThesecondaryoutcomewaspostoperativecomplicationsrelatedtothePCIprocedureormedicationuse.

Results:

Outofthe1,223patientsanalyzed,123(10.1%)developeduppergastrointestinalinjuryduringthe3-monthfollow-upperiod.Themajorityoftheinjuriesoccurredwithinthefirstmonthpost-PCI(86.2%).Thefactorsthatweresignificantlyassociatedwithuppergastrointestinalinjurywereage(p=0.002),malegender(p=0.002),hypertension(p=0.001),chronickidneydisease(p=0.022),heartfailure(p=0.046),postoperativecomplications(p<0.001),andintensityofantiplatelettherapy(p<0.001).

PatientswhoreceivedDAPThadahigherincidenceofuppergastrointestinalinjury(12.1%vs.5.5%,p<0.001)comparedtothosewhoonlyreceivedaspirin.AmongpatientsreceivingDAPT,theriskofuppergastrointestinalinjurywassignificantlyhigherinpatientsreceivinghigh-intensityDAPT(75.6%)comparedtothosereceivinglow-intensityDAPT(24.4%)(p<0.001).

Conclusion:

Inconclusion,theincidenceofuppergastrointestinalinjurywashigherinpatientsreceivingDAPTafterPCI.Age,gender,comorbidities,postoperativecomplications,andantiplatelettherapyintensitywereimportantfactorscontributingtotheinjury.Clinicalattentionandcontrolofthesefactorsshouldbeemphasized,andactivemeasuresshouldbetakentopreventandtreatpostoperativeuppergastrointestinalinjury.FurtherstudiesarewarrantedtoexplorestrategiestoreducetheriskofuppergastrointestinalinjuryinthispatientpopulationOnepotentialstrategytoreducetheriskofuppergastrointestinalinjuryinpatientsreceivingDAPTafterPCIistheuseofprotonpumpinhibitors(PPIs).PPIshavebeenshowntobeeffectiveinpreventinguppergastrointestinalinjuryinpatientsreceivingnonsteroidalanti-inflammatorydrugs(NSDs)andlow-doseaspirin,bothofwhichareknowntoincreasetheriskofuppergastrointestinalinjury.However,theuseofPPIsinpatientsreceivingDAPTafterPCIhasbeencontroversial.

SomestudieshavesuggestedthattheuseofPPIsinpatientsreceivingDAPTafterPCImayreducetheriskofuppergastrointestinalinjury,whileothershavefoundnobenefit.ThepotentialbenefitsofPPIsmustbeweighedagainsttheirpotentialrisks,includinganincreasedriskofadversecardiovasculareventsandinfections.

AnotherpotentialstrategytoreducetheriskofuppergastrointestinalinjuryinpatientsreceivingDAPTafterPCIistheuseoflessintenseantiplatelettherapy.Somestudieshavesuggestedthattheuseoflessintenseantiplatelettherapy,suchasclopidogrelaloneorashorterdurationofDAPT,maybeassociatedwithalowerriskofuppergastrointestinalinjury.However,theuseoflessintenseantiplatelettherapymustbebalancedagainstitspotentialimpactonstentthrombosisandadversecardiovascularevents.

Inconclusion,uppergastrointestinalinjuryisasignificantconcerninpatientsreceivingDAPTafterPCI.Age,gender,comorbidities,postoperativecomplications,andantiplatelettherapyintensityareimportantfactorscontributingtotheinjury.Clinicalatte