质子泵抑制剂在经皮冠状动脉介入治疗术后抗血小板治疗中的价值

目的 探讨质子泵抑制剂（proton pump inhibitor,PPI）对经皮冠状动脉介入治疗术（PCI）后抗血小板治疗中上消化道出血及不良心血管事件（MACCE）发生的影响.方法 选择在襄阳市中心医院心血管内科行PCI术的患者364例,术前、术后均给予氯吡格雷联合阿司匹林抗血小板治疗,随机分为3组：奥美拉唑组（n=121）、埃索美拉唑组（n=133）、对照组（n=110）.随访12个月,观察各组患者上消化道出血和MACCE的发生率.结果 奥美拉唑组、埃索美拉唑组、对照组上消化道出血发生率分别为2.48%、1.50%、10.91%,MACCE发生率分别为：9.09%、8.27%、8.18%.对照组的上消化道出血发生率显著高于奥美拉唑组和埃索美拉唑组,差异有统计学意义（P〈0.01）,而奥美拉唑组和埃索美拉唑组间的上消化道出血发生率差异无统计学意义（P〉0.05）.3组间的MACCE发生率差异无统计学意义（P〉0.05）.结论奥美拉唑与埃索美拉唑可预防对PCI后抗血小板治疗患者上消化道出血的发生,二者均不增加MACCE的发生率.

Value of proton pump inhibitors in the antiplatelet therapy after percutaneous coronary intervention

Objective To investigate the effect of proton pump inhibitors （PPI） on upper gartrointestinal bleeding and major adverse cardiovascular events （MACCE） in the antiplatelet therapy after pereutaneous coronary intervention （PCI）. Methods A total of 364 patients treated with clopidogrel and aspirin before and after PCI were randomly divid- ed into three group： omeprazol group （n = 121 ）, esomeprazole group （n = 133 ） and control group （n = 110）. The inci- dence rates of upper gartrointestinal bleeding and MACCE were observed. Results The incidence rates of upper gartroi- ntestinal bleeding in omeprazol group, esomeprazole group and control group were 2.48% , 1.50% , 10.91% , respce- tively, and the MACCE incidence rates were 9.09% , 8.27% , 8.18% , respcetively. The incidence rate of upper gart- rointestinal bleeding in control group was significantly higher than that in omeprazol group and esomeprazole group （ P 〈 0.05 ） , however, there was no significant difference between omeprazol group and esomeprazole group （ P 〉 0.05 ） ; there was no significant difference in MACCE incidence among 3 groups （P 〉 0.05）. Conclusion Omeprazol and es- omeprazole decrease the incidence of upper gartrointestinal bleeding in patients after PCI, and do not increase the inci- dence of MACCE.