不同抗血小板治疗方案对上消化道出血发生率影响.docVIP

不同抗血小板治疗方案对上消化道出血发生率的影响 　　[摘要] 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）。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）。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。 　　[关键词] 抗血小板；治疗方案；上消化道出血；影响因素 　　[中图分类号] R573 [文献标识码] A [文章编号] 1673-7210（2015）05（c）-0128-05 　　[Abstract] Objective To analyze the effect of different anti-platelet therapeutic schedules for incidence of upper gastrointestinal 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）. Single factor analysis for observation group showed that， gastrointestinal hemorrhage was rel