作　　者： (乔曼丽）; (毕齐）;

机构地区： 首都医科大学附属北京安贞医院全科医疗科,北京市100029

出　　处： 《中国全科医学》 2017年第22期2751-2756,共6页

摘　　要： 目的探讨既往脑出血患者经皮冠状动脉介入治疗(PCI)术后双重抗血小板治疗(双抗)住院期间安全性及有效性。方法收集2013年1月—2014年12月在首都医科大学附属北京安贞医院住院并行PCI术的患者19 233例。选取其中有脑出血病史患者25例作为观察组;按照1∶2比例选取同期住院年龄、性别、相关危险因素匹配的无脑出血病史的患者50例作为对照组。所有入选病例均在PCI术前开始服用阿司匹林100 mg,1次/d+氯吡格雷75mg,1次/d至出院。统计比较两组一般资料、住院期间双抗安全性(包括院内脑出血和主要出血、缺血性心脑血管病、任何原因导致死亡)及有效性(包括患者住院情况及PCI术情况),并分析其可能的机制。结果两组男性比例、年龄、高血压病史、糖尿病病史、高脂血症病史、冠心病病史、降压药物使用率、抗血小板药物使用率、降糖药物使用率、收缩压、舒张压、脉搏、空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白比较,差异无统计学意义(P>0.05);两组患者缺血性卒中/短暂性脑缺血发作(TIA)史、他汀类药物使用率、低密度脂蛋白比较,差异有统计学意义(P<0.05)。两组均未发生院内脑出血及主要出血,均未出现院内新发缺血性心脑血管病,观察组发生心源性死亡1例,对照组无死亡。两组住院时间、PCI术前双抗时间、急性心肌梗死发生率、抗凝药物使用率比较,差异有统计学意义(P<0.05);两组患者降糖药物、降压药物使用率比较,差异无统计学意义(P>0.05)。两组支架数分布、二次手术率比较,差异有统计学意义(P<0.05)。结论既往脑出血患者PCI术后双抗治疗住院期间并未增加脑出血及主要出血的风险,但住院期间死亡率有增加趋势;既往脑出血患者合并缺血性脑血管病的发生率更高,住院时间延长,冠心病病情较重,植入多个支架及院内二次手术的比例较高,但PCI术� Objective To investigate the safety and efficacy of dual antiplatelet therapy（ DAPT） applied to patients undergoing percutaneous coronary intervention（ PCI） with a history of cerebral hemorrhage during hospitalization.Methods From the 19 233 inpatients underwent PCI in Beijing Anzhen Hospital,Capital Medical University between January 2013 and December 2014,we selected 25 cases with a history of cerebral hemorrhage as the observation group for this study,and other 50 cases with matched age,sex,associated risk factors for the outcome but without the history of cerebral hemorrhage were selected as the control group based on the ratio of 1∶ 2.All of them took aspirin 100 mg qd plus clopidogrel 75 mg qd before the start of PCI to the discharge.We compared the baseline characteristics,safety of DAPT during hospitalization via analyzing the incidences of cerebral hemorrhage and other major hemorrhagic and ischemic cardiovascular and cerebrovascular diseases and all-cause mortality during hospitalization,efficacy of DAPT during hospitalization through analyzing the status of hospitalization and PCI,and analyzed the possible mechanisms.Results No differences were found between the groups in terms of proportion of males,age,hypertension history,diabetes history,hyperlipidemia history and coronary heart disease history,antihypertensive agents treatment history,antiplatelet agents treatment history and hypoglycemic agents treatment history,systolic blood pressure,diastolic blood pressure,pulse count,fasting plasma glucose,total cholesterol,triacylglycerol,and high-density lipoprotein（ P 0.05）.Compared with the control group,more patients in the observation group had a history of ischemic stroke or transient ischemic attack（ TIA）（ P 0.05） and higher level of low-density lipoprotein（ P 0.05） but less patients as a history of statins treatment（ P 0.05）.No cerebral hemorrhage and other major hemorrhagic and ischemic cardiovascular and cerebrovascular diseases occurred in both groups during hospital

关 键 词： 脑出血 血管成形术 气囊 冠状动脉 双重抗血小板治疗 安全 有效性研究