冠心病抗血小板治疗的新进展

冠心病抗血小板治疗的新进展上海第二医科大学附属瑞金医院心内科陈晓文综述戚文航审校血小板的活化在心血管血栓性疾病的发生发展中起着重要的作用。近年来，随着阿斯匹林、噻氯匹定等抗血小板药物在冠心病防治中取得了显著疗效，不少新的该类药物进入了临床试用阶段。其...     

急性冠状动脉综合征抗血小板治疗的新进展

<正>心血管病已经成为中国居民的首要死因。其中,半数为急性冠状动脉综合征(acute coronary syndrome,ACS)所致。现已经阐明,动脉粥样硬化斑块破裂引起血小板激活、黏附和聚集,致使冠状动脉血栓形成,是ACS发病的关键机制。因此,抗血小板是ACS药物治疗的基石。近年来,随着大量临床试验的展开和新型抗血小板药物的临床应用,抗血小板治疗领域取得许多新的突破。1口服抗血小板药物     

双重抗血小板治疗的胃肠道并发症

为预防和治疗心脑血管疾病及外周动脉血管病变,我们会联合应用阿司匹林和氯吡格雷行双重抗血小板治疗。在高危血管性疾病患者中行双重抗血小板治疗的获益可能会以胃肠道并发症为代价。严重的胃肠道并发症包括胃十二指肠溃疡所致胃肠道出血、穿孔和死亡。轻的并发症包括消化不良、药物性食管炎、上皮出血、糜烂以及胃十二指肠溃疡。进行抗血小板治疗出现胃肠道并发症的高危因素包括老年、有胃十二指肠溃疡病史、胃食管返流性疾病、食管炎、未治疗的Hp感染、肠道息肉或癌症以及抗凝剂、类固醇激素、非甾体类消炎药的使用。前列腺素合成被抑制…     

抗血小板治疗导致胃肠道损伤及其防治的研究进展

抗血小板药物治疗是进行心脑血管疾患预防及治疗的基石,广泛应用于临床.但长期使用可造成胃肠道损害,导致消化道出血等严重不良事件发生.如何在抗血小板治疗的同时进行消化系不良反应的防治,是目前临床面临的重要问题.本文就常用抗血小板药物阿司匹林和氯吡格雷导致胃肠道损害的作用机制、特点、防治措施等相关问题进行阐述,并对抗血小板药物相关消化道出血诊治指南和专家共识介绍.     

抗血小板治疗相关消化道出血浅析

抗血小板治疗自20世纪60年代在冠心病患者中应用以来,近30余年得到飞速发展,已成为冠心病治疗的基石。而在急性冠状动脉综合征(ACS)、药物洗脱支架(DES)置入术后患者中,双联抗血小板药物[阿司匹林联合血小板腺苷二磷酸(ADP)受体拮抗剂(如氯吡格雷)]治疗亦已成为常规治疗。然而业内对于接受双联抗血小板治疗最佳时长究竟为多少仍存在争议,近期《新英格兰杂志》总结美国心脏     

抗血小板治疗新进展

众所周知,血小板在动脉系统血栓形成中起着关键作用,抗血小板治疗已成为预防和治疗动脉系统血栓的基石。目前临床主要应用的抗血小板药物有阿司匹林、二磷酸腺苷（ADP）受体拮抗剂及Ⅱb／Ⅲa受体拮抗剂,在传统抗血小板药物的基础上,新的药物也在不断研发。但是,抗血小板治疗现状仍不理想,在临床抗血小板获益的同时,其局限性及治疗的特异性还存在诸多问题。本文拟以此为中心,结合抗血小板治疗的最新进展进行相关讨论。     

双联抗血小板治疗相关上消化道出血的临床特征

目的研究双联抗血小板治疗相关上消化道出血(UGIB)的临床特点。方法收集双联抗血小板治疗相关UGIB住院患者59例为观察组,随机选取同期非抗血小板治疗的UGIB患者120例作为对照组,对两组患者的临床资料进行比较。结果两组患者在性别、贫血程度、幽门螺杆菌感染等方面无显著差异(P>0.05)。但是观察组患者的年龄较对照组高(P=0.000),观察组出血之前缺乏典型腹痛症状者明显增多(P=0.000),出血症状中缺乏呕血和黑便症状,仅以乏力贫血就诊者明显增多(P=0.001)。观察组内镜表现为黏膜糜烂患者增多,但无统计学差异(P=0.269)。观察组患者均合并冠心病,57.63%合并急性冠脉综合征,与对照组有显著差异(均P=0.000)。观察组住院时间明显延长(P=0.000),病死率明显增高(P=0.023)。结论应加强对双联抗血小板治疗相关UGIB临床特点的认识,减少抗血小板药物不良反应。     

双联抗血小板治疗并高危消化道出血的临床用药

急性冠脉综合征（ACS）及经皮冠状动脉介入术（PCI）后患者应用双联抗血小板（阿司匹林＋氯吡格雷）要优于单一抗血小板药物治疗。但随着阿司匹林及氯毗格雷为代表的抗血小板药物在冠状动脉疾病中的广泛应用,与该类药物相关的胃肠道损伤亦随之备受关注。     

幽门螺杆菌感染与冠心病患者抗血小板治疗后上消化道出血的相关性研究

[目的]探讨幽门螺杆菌（Hp）感染与冠心病（CHD）患者抗血小板治疗后发生上消化道出血的相关性,并观察根治Hp预防上消化道出血的效果。[方法3120例Hp阳性的CHD患者和30例Hp阴性患者（Hp阴性组）纳入研究,均行抗血小板治疗。Hp阳性患者随机分为2组,各60例,观察组给予Hp根除治疗,并在4周后观察治疗效果。所有患者随访1年,比较各组上消化道出血事件发生率的差异。[结果]对照组上消化道出血发生率为11．67%（7／60）,高于观察组1．67％（1／60）和Hp阴性组的0（P〈0．05）。观察组行Hp根除治疗后仍有5％（3／60）为阳性,其中1例发生上消化道出血,而95％（57／60）转为阴性,且无上消化道出血发生（P〈0．05）。[结论]Hp感染可增加CHD患者抗血小板治疗时发生上消化道出血的风险,而根除Hp治疗能使出血风险降低。     

老年冠心病双联抗血小板治疗后上消化道出血的相关因素分析

目的分析老年冠心病(ACS)双联抗血小板治疗后上消化道出血的相关因素。方法选择我院2007年8月—2013年6月住院的因双联抗血小板治疗后上消化道出血老年ACS患者48例为出血组,选择同期住院治疗的老年ACS双联抗血小板治疗后未出血患者48例作为对照组。回顾性分析患者的临床资料,记录性别、年龄、肾功能、幽门螺杆菌(Hp)感染、负荷剂量、GRACE评分高危、联合口服质子泵抑制剂(PPI)、既往胃肠病史。结果出血组年龄、肾功能减退、Hp感染、负荷剂量、联合口服PPI、既往胃肠病史所占比例均高于对照组(P0.05)。两组患者性别和GRACE评分高危所占比例比较,差异无统计学意义(P0.05)。结论老年ACS双联抗血小板治疗后上消化道出血由多种原因引起,临床上应加强预防。     

P2Y12 Inhibitors Exacerbate Low-dose Aspirin-induced Small Bowel Injury in Dual Antiplatelet Therapy

Objective Antithrombotic drugs are being used increasingly frequently to prevent cardiovascular diseases. Few studies have evaluated small bowel mucosal injury induced by dual antiplatelet therapy (DAPT). The aim of the present study was to evaluate small bowel mucosal injury induced by DAPT compared with other antithrombotics using video capsule endoscopy (VCE). Methods The study included chronic users of antithrombotics who underwent VCE for obscure gastrointestinal bleeding between January 2007 and July 2018. We evaluated the instances of small bowel injury classified into erosions and ulcers. Results Overall, 183 patients (114 men and 69 women; mean age, 73.6 years old) were enrolled, and the study groups comprised 49 patients taking low-dose aspirin (LDA) only, 50 taking anticoagulants only, 37 being treated with DAPT, 33 on combined LDA and anticoagulants, and 14 taking P2Y12 inhibitors. Small bowel erosions and ulcers were most frequently observed in the DAPT group, with frequencies of 78.4% and 37.8%, respectively. Exacerbating factors of small bowel ulcers were DAPT [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.2-7.7] and age over 80 years old (OR 2.4, 95% CI 1.1-5.4). Conclusion P2Y12 inhibitors seem to exacerbate LDA-induced small bowel injury. Preventive strategies for small bowel injury induced by LDA, especially DAPT, are urgently required.     

上消化道大出血的分析研究

本文论述了上消化道大出血病因、诊断方法、止血措施等,重点阐述了三腔二囊管压迫止血、内镜下止血、经静脉肝内门体静脉分流术等止血的措施和方法,为消化道大出血临床实践提供了一定的理论指导.     

非静脉曲张性急性上消化道出血血清胃泌素检测及其临床意义

目的:了解非静脉曲张性急性上消化道出血血清胃泌素变化及其临床意义。方法:A组:急性非静脉曲张性上消化道出血34例;B组:活动期消化性溃疡29例;C组:慢性胃炎30例。采用放免法检测血清胃泌素。结果:A组血清胄泌素为97.94±22.75ng/L,95％可信限(95％CI)为92.08～103.80ng/L;B组胃泌素52.31±9.94ng/L,95％CI 48.70～55.94ng/L;C组胃泌素35.15±11.95ng/L,95％ CI 30.88～39.42ng/L。A组胃泌素显著高于B、C组(P<0.01),B组胃泌素也明显高于C组(P<0.05)。结论:胃泌素增多与消化道出血相关。     

隐源性消化道出血的病因及诊断分析

目的总结分析隐源性消化道出血的病因,探讨不同检查方法的诊断价值。方法对1992年至2004年的39例经手术治疗消化道大出血临床资料进行回顾性分析。结果39例患者均有病理诊断,所有病变以良性为主58.97%(23/39),病变部位以小肠居多89.74%(35/39)。与病理结果比,选择性动脉造影诊断符合率为56%(14/25),核素扫描定位诊断符合率为38.53%(13/34),小肠插管分段气钡造影诊断符合率为22.58%(7/31),术中内窥镜诊断符合率85.71%(6/7)。结论疑难消化道大出血病变多数在小肠,以良性病变为主,术前选择性动脉造影具有较高的定性和定位诊断价值。     

Diagnosis and Treatment of Acute Lower Gastrointestinal Bleeding

Diagnostic sigmoidoscopy and barium enema examinations (n = 214) or colonoscopy (n = 52) were performed for acute lower gastrointestinal (GI) bleeding. The cause of bleeding was detected in 76% (203 of 266) of the primary examinations, and the cause remained unclear after subsequent examinations in 17% of the cases. Hemorrhoids were the cause of bleeding in 28% (56 of 203) of the cases, colonic diverticular disease in 19% (39 of 203), adenomatous polyps in 11% (23 of 203), and colorectal cancer in 10% (20 of 203). The sources of bleeding did not differ significantly by sex. An anorectal site of bleeding was most often detected in patients less than 50 years of age (p < 0.0001) and a left colonic site in those more than 70 years (p < 0.0001). Hemorrhoids significantly more often caused rectal bleeding among the youngest patients (p < 0.0001) and colonic diverticular disease among the oldest patients (p < 0.0001) and colonic diverticular disease among the oldest patients (p < 0.0001) than among the others. Of the 266 patients, 19% have been operated on for the bleeding lesion. The mortality related to lower GI bleeding was 4% (11 of 266). The mean age of the patients who died was higher than that of those who survived (p < 0.05).     

Dual Antiplatelet Therapy Duration Based on Ischemic and Bleeding Risks After Coronary Stenting

Background

Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized.