使用替罗非班时泮托拉唑对非ST段抬高型急性冠脉综合征患者消化道保护作用的评

目的:盐酸替罗非班、阿司匹林、氯吡格雷、低分子肝素（四联）联合使用治疗急性冠脉综合征(ACS)患者时，评价静脉注射泮托拉唑对消化道保护的疗效和安全性。方法: 选择住院ACS患者296例，随机分为试药组184例，对照组112例，所有患者均服用阿司匹林、氯吡格雷、低分子肝素和使用2～3 d盐酸替罗非班。在此基础上试药组患者静脉输注泮托拉唑40 mg/d，4~5 d，再服用泮托拉唑片剂40 mg/次，2次/d，连服8 d。结果: 试药组8 d内全因死亡、顽固性心绞痛、再次心肌梗死、急诊经皮冠状动脉介入治疗(PCI)数较对照组显著减少（P<0.05）；试药组与对照组比较消化道出血发生率（2.2% vs. 12.5%）、TIMI小出血发生率(1.6% vs. 6.2%)和TIMI较小出血发生率(0.5% vs. 5.4%)明显降低（P<0.05）。结论: 在四联抗栓治疗ACS患者时，静脉注射和口服泮托拉唑可以减少8 d内消化道出血发生率，从而减少了8 d内患者死亡、顽固性心绞痛、再次心肌梗死、急诊PCI数，具有良好的消化道保护作用和安全性。

Evaluation of the efficacy and safety of pantoprazole with tirofiban in protecting the alimentary canal of non-ST elevation acute coronary syndrome

AIM: To evaluate the efficacy and safety of protecting the alimentary canal with pantoprazole when using the quadruple therapy: aspirin,clopidogrel,low molecular weight heparin(LMWH) and tirofiban hydrochloride in acute coronary syndrome(ACS).METHODS: Two hundred and ninety-six selected hospitalized patients with ACS were divided into observation group(n=184) and control group(n=112).Aspirin,clopidogrel,LMWH and 2-3 days of tirofiban were administered to all patients.On this basis,pantoprazole 40 mg i.v.was first administered by drip phleboclysis for 4-5 days and then changed to tablets(40 mg twice daily) for 8 days in the observation group.RESULTS: Occurrence of 8-day all-cause death,refractory angina pectoris,relapse myocardial infarction and emergency percutaneous coronary intervention(PCI) in the observation group was lower than that in the control group(P<0.05).The number of total hemorrhages,mild hemorrhages and midrange hemorrhages in the control group was higher than in the observation group(P<0.05).CONCLUSION: Intravenous injection and oral administration of pantoprazole decreased the 8-day rate of alimentary tract hemorrhage when using the quadruple anti-thrombosis therapy for ACS,thus decreasing the number of all-cause death for 8 days,intractable angina pectoris,intractable angina,relapse myocardial infarction and emergency PCI.