单用或联用抗血小板药物致上消化道出血临床分析.docVIP

单用或联用抗血小板药物致上消化道出血临床分析 　　摘要：目的 分析单用或联合服用抗血小板药物是否会增加严重上消化道出血的发生率及相关影响因素。方法 回顾性分析175例住院患者的临床资料，根据患者起病前是否服用抗血小板药分为：对照组（A组，无服药史），药物组（B组）：包括阿司匹林（100～300 mg/d）、氯吡格雷（75 mg/d）；按药物类别将药物组（B组）分为阿司匹林组（B1组，单纯服用阿司匹林）、阿司匹林+氯吡格雷组（B2组，同时服用阿司匹林+氯吡格雷）。结果 B组年龄高于A组（66.72±9.99岁 VS 55.79±12.07岁，t=-6.230，P0.05）。B组严重上消化道出血率高于A组（？字2=6.118，P=0.013），B2组严重上消化道出血率高于B1组（？字2=4.498，P=0.034）；内镜下表现A组以十二指肠溃疡为主，B组以胃溃疡为主；B组中既往有溃疡史或上消化道出血史患者严重性上消化道出血率高于无溃疡史或上消化道出血史患者（？字2=10.53，P=0.001）。B组中联合使用PPI患者严重性上消化道出血率低于未使用PPI患者（？字2=8.339，P=0.004）。结论 单用或联合服用抗血小板可增加患者严重上消化道出血的发生率，内镜下表现以胃溃疡为主，年龄、既往溃疡史或上消化道出血史、联合使用PPI是其重要影响因素。 　　关键词：阿司匹林； 氯吡格雷； 上消化道出血；Blatchford评分 　　中图分类号：R571 文献标识码：A 　　Abstract：Objective To investigate the risk factors and the incidence of severe upper gastrointestinal bleeding （UGIB） induced by only one or dual anti-platelet therapy. Methods A retrospective review of the clinical dates of 175 patients was conducted.All patients were divided into control group （group A） and drug group （group B） based on whether consumed anti-platelets. According to the type of anti-platelets including aspirin （100～300 mg/d） and/or clopidogrel （75 mg/d）， patients in group B were divided into group B1 （using aspirin） and group B2 （using aspirin and clopidogrel）. Results Patients in group B were older than patients in group A （66.72±9.99 years VS 55.79±12.07 years，t=-6.230 P0.05）. The occurrence rate of severe UGIB in group B was higher than group A（？字2=6.118，P=0.013）. The occurrence rate of severe UGIB in group B2 was higher than group B1（？字2=4.498，P=0.034）. In this study the most common source of bleeding was duodenal ulcer in group A， but it was gastric ulcer in group B. The patients with the history of ulcer or UGIB occurred severe UGIB more than those without the history of ulcer or UGIB in group B（？字2=10.53，P=0.001）. When combined with proton pump inhibitor （PPI）， the occurrence rate of sever UGIB was lower in group B（？字2=8.339，P=0.004）. Conclusion The incidence of severe UGIB induced by only one or dual anti