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目的观察泮托拉唑钠注射剂联合氯吡格雷片治疗急性心肌梗死伴消化道出血的临床疗效及安全性。方法将44例急性心肌梗死并消化道出血患者随机分为对照组22例和试验组22例。对照组予以氯吡格雷75 mg,qd,口服+奥美拉唑每次20 mg,bid,口服;试验组予以氯吡格雷75 mg,qd,口服+泮托拉唑钠40 mg,qd,静脉滴注。2组患者均治疗7d。比较2组患者的临床疗效、前列腺素E_2水平、心血管事件及药物不良反应的发生情况。结果治疗后,试验组和对照组的总有效率分别为86.36%(19/22例)和59.09%(13/22例),差异有统计学意义(P<0.05)。治疗3,5,7 d后,试验组的前列腺素E_2,水平分别为(81.03±18.48),(116.70±21.93),(149.93±27.52)ng·mL~(-1),对照组的前列腺素E_2水平分别为(67.09±15.20),(92.56±16.34),(120.08±20.05)ng·mL~(-1),差异均有统计学意义(P<0.001)。随访3个月,试验组和对照组的心血管事件发生率均为18.18%,差异无统计学意义(P>0.05)。试验组发生的药物不良反应主要有便秘、过敏性皮炎、肾功能下降,对照组发生的药物不良反应主要有便秘和过敏性皮炎,且试验组和对照组的药物不良反应发生率分别为18.18%和13.64%,差异无统计学意义(P>0.05)。结论泮托拉唑钠注射剂联合氯吡格雷片治疗急性心肌梗死伴消化道出血的临床疗效显著,可显著提高患者的血清前列腺素E_2水平,且不增加心血管事件和药物不良反应的发生率。
Objective To observe the clinical efficacy and safety of pantoprazole sodium injection combined with clopidogrel in the treatment of acute myocardial infarction with gastrointestinal bleeding. Methods Forty-four patients with acute myocardial infarction and gastrointestinal bleeding were randomly divided into control group (22 cases) and experimental group (22 cases). The control group was given clopidogrel 75 mg qd orally + omeprazole 20 mg once daily bid. The experimental group was given clopidogrel 75 mg qd orally and pantoprazole sodium 40 mg qd intravenously Drip. Two groups of patients were treated for 7 days. The clinical efficacy, prostaglandin E2 level, cardiovascular events and adverse drug reactions were compared between the two groups. Results After treatment, the total effective rates of the experimental group and the control group were 86.36% (19/22 cases) and 59.09% (13/22 cases), respectively, with statistical significance (P <0.05). The levels of prostaglandin E_2 in the experimental group were (81.03 ± 18.48), (116.70 ± 21.93) and (149.93 ± 27.52) ng · mL -1 after treatment for 3, 5 and 7 days respectively. The levels of prostaglandin E_2 levels were (67.09 ± 15.20), (92.56 ± 16.34) and (120.08 ± 20.05) ng · mL -1, respectively, with statistical significance (P <0.001). The follow-up of 3 months, the experimental group and control group, the incidence of cardiovascular events were 18.18%, the difference was not statistically significant (P> 0.05). Adverse reactions to the test group mainly constipation, atopic dermatitis, decreased renal function, adverse reactions in the control group mainly constipation and allergic dermatitis, and the experimental group and control group, the incidence of adverse drug reactions were 18.18% And 13.64%, the difference was not statistically significant (P> 0.05). Conclusion The clinical efficacy of pantoprazole sodium injection and clopidogrel tablets in the treatment of acute myocardial infarction with gastrointestinal bleeding is significant, which can significantly increase the serum prostaglandin E2 level without increasing the incidence of cardiovascular events and adverse drug reactions.