本文選題：腦出血　切入點(diǎn)：血管成形術(shù)　出處：《中國全科醫(yī)學(xué)》2017年22期

【摘要】：目的探討既往腦出血患者經(jīng)皮冠狀動脈介入治療(PCI)術(shù)后雙重抗血小板治療(雙抗)住院期間安全性及有效性。方法收集2013年1月—2014年12月在首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院住院并行PCI術(shù)的患者19 233例。選取其中有腦出血病史患者25例作為觀察組;按照1∶2比例選取同期住院年齡、性別、相關(guān)危險因素匹配的無腦出血病史的患者50例作為對照組。所有入選病例均在PCI術(shù)前開始服用阿司匹林100 mg,1次/d+氯吡格雷75mg,1次/d至出院。統(tǒng)計比較兩組一般資料、住院期間雙抗安全性(包括院內(nèi)腦出血和主要出血、缺血性心腦血管病、任何原因?qū)е滤劳?及有效性(包括患者住院情況及PCI術(shù)情況),并分析其可能的機(jī)制。結(jié)果兩組男性比例、年齡、高血壓病史、糖尿病病史、高脂血癥病史、冠心病病史、降壓藥物使用率、抗血小板藥物使用率、降糖藥物使用率、收縮壓、舒張壓、脈搏、空腹血糖、總膽固醇、三酰甘油、高密度脂蛋白比較,差異無統(tǒng)計學(xué)意義(P0.05);兩組患者缺血性卒中/短暫性腦缺血發(fā)作(TIA)史、他汀類藥物使用率、低密度脂蛋白比較,差異有統(tǒng)計學(xué)意義(P0.05)。兩組均未發(fā)生院內(nèi)腦出血及主要出血,均未出現(xiàn)院內(nèi)新發(fā)缺血性心腦血管病,觀察組發(fā)生心源性死亡1例,對照組無死亡。兩組住院時間、PCI術(shù)前雙抗時間、急性心肌梗死發(fā)生率、抗凝藥物使用率比較,差異有統(tǒng)計學(xué)意義(P0.05);兩組患者降糖藥物、降壓藥物使用率比較,差異無統(tǒng)計學(xué)意義(P0.05)。兩組支架數(shù)分布、二次手術(shù)率比較,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論既往腦出血患者PCI術(shù)后雙抗治療住院期間并未增加腦出血及主要出血的風(fēng)險,但住院期間死亡率有增加趨勢;既往腦出血患者合并缺血性腦血管病的發(fā)生率更高,住院時間延長,冠心病病情較重,植入多個支架及院內(nèi)二次手術(shù)的比例較高,但PCI術(shù)前使用雙抗的時間短,既往他汀類藥物及院內(nèi)抗凝藥物使用率低,需在PCI過程中加以注意。
[Abstract]:Objective to investigate the safety and efficacy of dual antiplatelet therapy (double antiplatelet therapy) after percutaneous coronary intervention (PCI) in patients with cerebral hemorrhage.Methods from January 2013 to December 2014, 19 233 patients underwent PCI surgery in Beijing Anzhen Hospital affiliated to Capital Medical University.All patients were treated with aspirin 100 mg / d before PCI, 75 mg / d clopidogrel per day and discharged from the hospital.The general data of the two groups were compared statistically. The safety of double antibodies during hospitalization (including nosocomial intracerebral hemorrhage and major hemorrhage, ischemic cardio-cerebrovascular disease) was compared.Any cause of death) and effectiveness (including patient hospitalization and PCI procedure) and analysis of its possible mechanisms.Results the male ratio, age, history of hypertension, history of diabetes, history of hyperlipidemia, history of coronary heart disease, utilization rate of antihypertensive drugs, utilization rate of antiplatelet drugs, utilization rate of hypoglycemic drugs, systolic blood pressure, diastolic blood pressure, pulse,There was no significant difference in fasting blood glucose, total cholesterol, triacylglycerol and high density lipoprotein between the two groups; the history of ischemic stroke / transient ischemic attack (TIA), the use of statins, and the comparison of low density lipoprotein (LDL) between the two groups.The difference was statistically significant (P 0.05).No nosocomial intracerebral hemorrhage or major hemorrhage was found in both groups, and no new ischemic cardio-cerebrovascular disease occurred in the hospital. One case of cardiogenic death occurred in the observation group and no death occurred in the control group.There were significant differences in the number of stents and the rate of secondary operation between the two groups (P 0.05).Conclusion the risk of intracerebral hemorrhage and major hemorrhage was not increased during the hospitalization of patients with previous cerebral hemorrhage after PCI, but the mortality rate increased during hospitalization, and the incidence of ischemic cerebrovascular disease was higher in patients with previous cerebral hemorrhage.
【作者單位】： 首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院全科醫(yī)療科;首都醫(yī)科大學(xué)附屬北京安貞醫(yī)院神經(jīng)內(nèi)科;
【分類號】：R743.34

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本文編號：1722550