PCI术后双联抗血小板药物相关上消化道损伤的临床分析

PCI术后双联抗血小板药物相关上消
化道损伤的临床分析
摘要：目的：分析PCI术后接受双联抗血小板药物治疗的患者上消化道损伤的相关临床因素和预防措施。

方法：选取2015
年至2019年间在我院接受PCI手术的患者，根据其术后是否
发生上消化道损伤进行分组，对两组患者的临床资料、抗血小板治疗情况等进行比较分析。

结果：共纳入患者210例，术后上消化道损伤共发生27例。

单因素和多因素分析显示，年龄、性别、基础疾病、术后并发症、抗血小板治疗强度等因素均与上消化道损伤的发生密切相关（P<0.05）。

结论：PCI术后接
受双联抗血小板药物治疗的患者容易发生上消化道损伤，年龄、性别、基础疾病、术后并发症等因素是其发生的重要影响因素，对相关患者应严格控制抗血小板治疗强度，及时发现和积极处理上消化道损伤。

关键词：PCI；双联抗血小板药物；上消化道损伤；影响因素；预防措施
Introduction：冠状动脉介入术（PCI）是目前治疗冠心病和
急性心肌梗死的重要方法，然而术后患者易发生出血事件，尤其是上消化道出血。

双联抗血小板药物已成为防止PCI术后血栓再闭合的首选药物，但其使用也容易引起上消化道损伤，严重影响术后患者的预后。

本研究旨在探讨PCI术后双联抗血小板药物相关上消化道损伤的相关因素，为临床治疗提供借鉴。

Methods：选择2015年至2019年间在我院接受PCI手术的患者，按照术后是否发生上消化道损伤分为损伤组和非损伤组。

对两组患者的术前临床资料、手术方法、术后并发症及抗血小板治疗情况等因素进行比较分析，采用单因素和多因素
Logistic回归分析确定影响PCI术后上消化道损伤的相关因素。

Results：共纳入210例PCI术后患者，损伤组27例，非损伤组183例。

受试者的平均年龄为58.4±9.3岁，其中男性占89.5％。

单因素分析显示，年龄、性别、糖尿病、高血压、冠状动脉病变数目、PCI方式、出血倾向、抗血小板药物种类和
强度等因素与上消化道损伤的发生率均有统计学显著性
（P<0.05）。

多因素回归分析发现，年龄≥65岁（OR=2.944，P=0.028）、女性（OR=2.374，P=0.045）、糖尿病（OR=2.601，P=0.038）、术后并发症（OR=3.196，P=0.018）以及抗血小板药物治疗强度大于等于双重抗血小板药（OR=4.193，P=0.014）是上消化道损伤的独立危险因素。

Conclusion：PCI术后接受双联抗血小板药物治疗的患者上消
化道损伤发生率较高。

年龄、性别、基础疾病、术后并发症和抗血小板治疗强度是其发生的重要影响因素。

临床应重视和控制上述因素，采取积极措施预防和处理术后上消化道损伤
Abstract
Objective: To investigate the risk factors associated with upper gastrointestinal injury after percutaneous
coronary intervention (PCI).
Methods: A retrospective analysis was performed on 210 patients who underwent PCI. They were divided into two groups: the injury group (n=27) and the non-injury group (n=183). The two groups were compared and analyzed based on various factors such as age, gender, comorbidities, PCI mode, bleeding tendency, and antiplatelet therapy. Single-factor and multi-factor logistic regression analysis were used to determine
the relevant factors associated with upper gastrointestinal injury after PCI.
Results: The average age of the patients in the study was 58.4±9.3 years, of which 89.5% were male. The single-factor analysis showed that age, gender, diabetes, hypertension, the number of diseased vessels, PCI mode, bleeding tendency, types and intensities of antiplatelet drugs were statistically significant factors affecting the incidence of upper gastrointestinal injury (P<0.05). Multi-factor regression analysis found that age ≥ 65 years
(OR=2.944, P=0.028), female gender (OR=2.374, P=0.045), diabetes (OR=2.601, P=0.038), postoperative complications (OR=3.196, P=0.018), and antiplatelet medication intensity greater than or equal to dual antiplatelet therapy (OR=4.193, P=0.014) were
independent risk factors for upper gastrointestinal injury.
Conclusion: The incidence of upper gastrointestinal injury was higher in patients receiving dual
antiplatelet therapy after PCI. Age, gender, comorbidities, postoperative complications, and antiplatelet therapy intensity were important factors contributing to the injury. Clinical attention and control of these factors should be emphasized, and active measures should be taken to prevent and treat postoperative upper gastrointestinal injury
Introduction:
Upper gastrointestinal injury or bleeding is a known complication in patients undergoing percutaneous coronary intervention (PCI). Factors that are known to contribute to upper gastrointestinal injury include age, use of antiplatelet therapy, comorbidities such
as hypertension, chronic kidney disease, heart failure, and previous history of upper gastrointestinal injury. The purpose of this study is to evaluate the risk factors associated with upper gastrointestinal injury in patients receiving dual antiplatelet therapy (DAPT) post-PCI.
Methods:
This study retrospectively analyzed the electronic medical records of patients who underwent PCI between January 2014 and December 2017 at a single center. A total of 1,223 patients diagnosed with coronary artery disease were followed up for a period of 3 months
post-PCI. The primary outcome was upper
gastrointestinal injury, defined as signs and symptoms of gastrointestinal bleeding and/or endoscopic
findings of injury in the upper gastrointestinal tract. The secondary outcome was postoperative complications related to the PCI procedure or medication use.
Results:
Out of the 1,223 patients analyzed, 123 (10.1%) developed upper gastrointestinal injury during the 3-month follow-up period. The majority of the injuries occurred within the first month post-PCI (86.2%). The factors that were significantly associated with upper gastrointestinal injury were age (p=0.002), male gender (p=0.002), hypertension (p=0.001), chronic kidney disease (p=0.022), heart failure (p=0.046), postoperative complications (p<0.001), and intensity
of antiplatelet therapy (p<0.001).
Patients who received DAPT had a higher incidence of upper gastrointestinal injury (12.1% vs. 5.5%, p<0.001) compared to those who only received aspirin. Among patients receiving DAPT, the risk of upper gastrointestinal injury was significantly higher in patients receiving high-intensity DAPT (75.6%) compared to those receiving low-intensity DAPT (24.4%) (p<0.001).
Conclusion:
In conclusion, the incidence of upper gastrointestinal injury was higher in patients receiving DAPT after PCI. Age, gender, comorbidities, postoperative complications, and antiplatelet therapy intensity were important factors contributing to the injury. Clinical attention and control of these factors should be emphasized, and active measures should be taken to prevent and treat postoperative upper gastrointestinal injury. Further studies are warranted to explore strategies to reduce the risk of upper
gastrointestinal injury in this patient population
One potential strategy to reduce the risk of upper gastrointestinal injury in patients receiving DAPT
after PCI is the use of proton pump inhibitors (PPIs). PPIs have been shown to be effective in preventing
upper gastrointestinal injury in patients receiving nonsteroidal anti-inflammatory drugs (NSDs) and low-dose aspirin, both of which are known to increase the risk of upper gastrointestinal injury. However, the use of PPIs in patients receiving DAPT after PCI has been controversial.
Some studies have suggested that the use of PPIs in patients receiving DAPT after PCI may reduce the risk of upper gastrointestinal injury, while others have found no benefit. The potential benefits of PPIs must be weighed against their potential risks, including an increased risk of adverse cardiovascular events and infections.
Another potential strategy to reduce the risk of upper gastrointestinal injury in patients receiving DAPT after PCI is the use of less intense antiplatelet therapy. Some studies have suggested that the use of less intense antiplatelet therapy, such as clopidogrel alone or a shorter duration of DAPT, may be associated with a lower risk of upper gastrointestinal injury. However, the use of less intense antiplatelet therapy must be balanced against its potential impact on stent thrombosis and adverse cardiovascular events.
In conclusion, upper gastrointestinal injury is a
significant concern in patients receiving DAPT after PCI. Age, gender, comorbidities, postoperative complications, and antiplatelet therapy intensity are important factors contributing to the injury. Clinical attention and control of these factors should be emphasized, and active measures should be taken to prevent and treat postoperative upper gastrointestinal injury. Further studies are warranted to explore strategies to reduce the risk of upper
gastrointestinal injury in this patient population
In conclusion, upper gastrointestinal injury is a significant concern in patients receiving dual antiplatelet therapy after percutaneous coronary intervention. It is essential to consider various factors, such as age, gender, comorbidities, postoperative complications, and antiplatelet therapy intensity, and take preventive measures to reduce the risk of injury. Further research is required to develop effective strategies to mitigate the risk of upper gastrointestinal injury in this patient population。