泮托拉唑钠联合硫酸氢氯吡格雷在急性心肌梗死伴消化道出血患者中的应用价值-现代医学

泮托拉唑钠联合硫酸氢氯吡格雷在急性心肌梗死伴消化道出血患者中的应用价值

单位：三亚市人民医院老年病科, 海南三亚 572500

分类号：R541.4

出版年·卷·期（页码）：2018·46·第一期（66-69）

摘要：

目的：探讨在硫酸氢氯吡格雷片（波立维）治疗的急性心肌梗死伴消化道出血患者中应用泮托拉唑钠注射剂的疗效。方法：以我院收治的48例急性心肌梗死伴消化道出血患者为研究对象，采用随机数字表法将其分为对照组和观察组。对照组给予波立维（75 mg·d^-1）联合奥美拉唑肠溶片（洛赛克，40 mg·d^-1）治疗，观察组给予波立维（75 mg·d^-1）联合泮托拉唑钠注射液（40 mg·d^-1）治疗。比较两组消化道出血的疗效、不良反应发生率、波立维血药浓度、血小板最大抑制率（MAR）和治疗后3个月的全因死亡率以及主要心血管事件（MACCE）发生情况。结果：治疗总有效率观察组明显高于对照组（87.50%vs.58.33%，P<0.05），两组不良反应发生率差异无统计学意义（16.67%vs.12.50%，P>0.05）。与应用质子泵抑制剂（PPI）前比较，应用PPI后两组的波立维血药浓度和MAR均明显降低（P<0.05），但观察组的血药浓度和MAR均高于对照组（P<0.05）。两组之间全因死亡率比较，差异无统计学意义（20.83%和37.50%，P>0.05）；MACCE发生的风险对照组明显高于观察组（HR=2.133，P<0.05）。结论：泮托拉唑钠注射剂联合波立维治疗急性心肌梗死伴消化道出血的疗效较好，对波立维有效浓度和抗血小板聚集作用的影响较小，并可以降低MACCE的发生风险。

Objective:To explorer the value of clopidogrel bisulfate tablets (plavix) combined application with pantoprazole sodium injection on the acute myocardial infarction (AMI) with gastrointestinal bleeding (GIB).Methods:Forty-eight AMI patients with GIB were enrolled in this study and were randomly divided into control group and observation group. Patients in the control group received plavix (75 mg·d^-1) combined with omeprazole enteric-coated capsules (losec, 40 mg·d^-1), while the observation group received plavix (75 mg·d^-1) combined with pantoprazole sodium injection (40 mg·d^-1). The clinical efficacy, adverse reactions, plasma concentration of plavix, maximal platelet inhibitory rate(MAR), all-cause mortality and major cardiovascular events (MACCE) of the two groups were comparatively analyzed.Results:The effective rates of the observation group were higher than that of the control group (87.50% vs. 58.33%,P<0.05).There was no statistical difference in the incidence of adverse reactions between the control group and observation group (16.67% vs. 12.50%,P>0.05).Compared with pre-treatment byproton pump inhibitor(PPI),the plasma concentration of plavix and the MAR of thetwo groups were much lower after using PPI (P<0.05).But the plasma concentration of plavix and MAR in observation group were significantly higher than those in the control group after using PPI (P<0.05). There was not significant difference in all-cause mortality between the two groups (20.83% vs. 37.50%,P>0.05), but the MACCE risk of the control group was significantly higher than that of the observation group(HR=2.133, P<0.05).Conclusion:Pantoprazole sodium injection combined with plavix is effective in treating acute myocardial infarction with gastrointestinal bleeding,and has less effect on the concentration of plavix and antiplatelet aggregation effects, and the combine also can reduce the risk of MACCE.

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