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口服云南白药和凝血酶联合质子泵抑制剂治疗经皮冠脉介入术后上消化道出血的临床观察

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第4期
页码:
507-509
栏目:
临床研究
出版日期:
2012-08-25

文章信息/Info

Title:
Clinical observation of oral Yunnan Baiyao and thrombin combined with proton pump inhibitors for treatment of upper gastrointestinal hemorrhage after percutaneous coronary intervention
作者:
刘胜强1; 雷新军2; 王东琦2; 袁 博1; 任 晖1; 张军康1
(1.安康市中心医院心内科，陕西 安康 725000；2.西安交通大学第一附属医院心内科，陕西 西安 710061)
Author(s):
LIU Sheng-qiang1;  LEI Xin-jun2;  WANG Dong-qi2;  YUAN Bo1;  REN Hui1;  ZHANG Jun-kang1
(1.Department of Cardiology, Ankang Central Hospital, Ankang 725000, Shaanxi, China; 2.Department of Cardiology, First Affiliated Hospital, Xi'an Jiaotong University, Xi’an 710061, Shaanxi, China)
关键词:
经皮冠状动脉介入治疗; 上消化道出血; 云南白药; 凝血酶; 质子泵抑制剂
Keywords:
percutaneous coronary intervention;  upper gastrointestinal hemorrhage;  Yunnan Baiyao;  thrombin;  proton pump inhibitors
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
目的:评价口服云南白药和凝血酶联合质子泵抑制剂(PPI)治疗冠心病患者行经皮冠状动脉介入治疗(PCI)术后上消化道出血的临床效果及安全性。方法： 选择PCI治疗术后服用阿司匹林+氯吡格雷行双联抗血小板聚集治疗期间发生上消化道出血的病例77例，随机分成口服云南白药和凝血酶的治疗组39例和口服去甲肾上腺素的对照组38例。两组患者均静脉使用PPI治疗，依据失血量情况给予补液、必要时输注新鲜血液及血浆等救治措施。治疗组给予云南白药1.0 g+凝血酶1 000 U+4℃生理盐水100 ml口服、每6 h 服1次；而对照组给予去甲肾上腺素8 mg+4℃生理盐水100 ml口服、每6 h服1次，对比观察两组患者服药72 h后消化道出血的止血率及120、168 h后的粪便潜血情况。结果： 云南白药治疗组患者72 h后消化道止血率明显好于对照组（92% vs. 74%,P<0.05）、而输血量少于对照组［(1.5±0.3) U vs. (1.8±0.5) U,P<0.01］及120、168 h后的粪便潜血好转率均明显好于对照组(95% vs. 76%,P<0.05；90% vs. 71%,P<0.05)，且未见有支架内血栓形成事件发生。结论： 口服云南白药和凝血酶联合PPI治疗PCI术后上消化道出血安全有效,值得在临床应用。
Abstract:
AIM:To evaluate the clinical effect and safety of oral Yunnan Baiyao and thrombin combined with proton pump inhibitors (PPI) for the treatment of upper gastrointestinal hemorrhage induced by combined application of clopidogrel and aspirin in patients undergoing percutaneous coronary intervention (PCI). METHODS: A total of 77 patients with post-PCI upper gastrointestinal hemorrhage and medication of clopidogrel and aspirin were randomly divided into treatment group (39 cases) and control group (38 cases). In the treatment group, Yunnan Baiyao (1.0 g) plus thrombin (1 000 U) was dissolved in 4℃ normal saline (100 ml) and was orally administered once every 6 h, whereas in the control group norepinephrine (8.0 mg) was dissolved in 4℃ normal saline (100 ml) and orally administered once every 6 h. PPI, necessary fluid replacement and blood transfusion were given in both groups and the rates of hemorrhage cessation at 72 h and occult blood in stool at 120 h and 168 h were observed. RESULTS: The rates of hemorrhage cessation in the treatment group were obviously higher than in the control group (92% vs. 74%, P<0.05), and the amount of blood transfusion was obviously lower than in the control group at 72 h ［(1.5±0.3) U vs. (1.8±0.5) U, P<0.01］. The rates of cessation of occult blood in stool in the treatment group were obviously higher than in the control group at 120 h and 168 h (95% vs. 76%, P<0.05; 90% vs. 71%, P<0.05) and no event of in-stent thrombosis occurred. CONCLUSION: Oral Yunnan Baiyao and thrombin are effective and safe in the treatment of upper gastrointestinal hemorrhage induced by combined application of clopidogrel and aspirin in patients undergoing PCI.

参考文献/References

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备注/Memo

备注/Memo:
收稿日期：2011-10-26.作者简介：刘胜强，主治医师，硕士Email：liushengqiang666-8@163.com.cn
更新日期/Last Update: 2012-07-20