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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
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创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
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王长华1*,王世爱2,王 健1,王韶屏1,郑 泽1,柳景华1,陈韵岱3.冠心病患者择期PCI术后消化道大出血的危险因素[J].中华老年多器官疾病杂志,2016,15(10):739~743
冠心病患者择期PCI术后消化道大出血的危险因素
Predictive risk factors for massive gastrointestinal hemorrhage in patients with coronary artery disease after elective percutaneous coronary intervention
投稿时间:2016-06-07  
DOI:10.11915/j.issn.1671-5403.2016.10.176
中文关键词:  冠心病;经皮冠状动脉介入治疗;消化道大出血
英文关键词:coronary artery disease; elective percutaneous coronary intervention; massive gastrointestinal hemorrhage
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作者单位E-mail
王长华1*,王世爱2,王 健1,王韶屏1,郑 泽1,柳景华1,陈韵岱3 1首都医科大学附属北京安贞医院心血管内科,北京市心肺血管研究所,北京 100029;2山东省济南市济钢总医院心血管内科,济南 250101;3解放军总医院心血管内科,北京 100853 wch1201@126.com 
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中文摘要:
      目的 研究冠心病患者择期经皮冠状动脉介入治疗(PCI)术后消化道大出血(MGH)的发生率及危险因素。方法 连续入选2012年1月至2014年12月期间在首都医科大学附属北京安贞医院心血管内科行择期PCI的非ST段抬高型急性冠脉综合征患者4239例。根据择期PCI术后1年内是否发生MGH分为两组:MGH组(n=47)和非MGH组(n=4192)。对比两组患者的临床资料及随访1年后的MGH事件及死亡率。结果 随访1年,MGH的发生率为1.11%(47/4239)。MGH组患者术前使用华法林和低分子肝素的比例显著高于非MGH组(P<0.05)。多元logistic回归分析显示,冠心病择期PCI患者术后MGH的独立危险因素为>75岁(OR=1.25,P=0.031)、贫血(OR=1.18,P=0.037)、消化道出血史(OR=1.49,P=0.005)和慢性肾功能不全(OR=2.27,P=0.001)。随访1年后,MGH组患者的死亡率显著高于非MGH组(64% vs 3.2%,P<0.001)。结论 使用抗血小板聚集药物时应根据患者的年龄、体质量和肾功能调整药物类型和剂量,并注意积极纠正贫血和保护肾功能。
英文摘要:
      Objective To investigate the incidence and risk factors of massive gastrointestinal hemorrhage (MGH) in the patients with coronary artery diseases treated with elective percutaneous coronary intervention (PCI). Methods Consecutive 4239 patients with non-ST elevation acute coronary syndrome successfully treated with elective PCI in Anzhen Hospital from January 2012 to December 2014 were enrolled in this study. According to the occurrence of MGH or not within 1 year after PCI, the subjects were divided into MGH group (n=47) and non-MGH group (n=4192). The clinical data, MGH events and mortality in 1 year of follow-up were compared between the 2 groups. Results The incidence of MGH was 1.11% (47/4239) in the subjects. The proportion of the patients with preoperative administration of warfarin and low-molecular-weight heparin was significantly higher in the MGH group than in the non-MGH group (P<005). Multivariate logistic regression analysis revealed that advanced age (>75 years, OR=125, P=0031), anemia (OR=118, P=0037), history of gastrointestinal hemorrhage (OR=149, P=0005) and chronic renal insufficiency (OR=227, P=0001) were independent predictors for MGH in the patients undergoing elective PCI. In 1 year’s follow-up, the mortality was obviously higher in the MGH group than in the non-MGH group (64% vs 32%, P<0001). Conclusion Clinicians should adjust the type and dosage of antiplatelet drugs based on the patient’s age, body mass and renal function, and correct anemia and protect renal function to decrease the occurrence of MGH.
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