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目的分析我院活血化瘀类辅助药物在急性冠脉综合征(acute coronary syndrome,ACS)患者中的使用情况,探讨该类药物对上消化道出血(upper gastrointestinal haemorrhage,UGH)的影响,为临床合理应用活血化瘀类辅助药物提供参考。方法选取我院2016年5月至7月ACS患者,根据是否使用活血化瘀类辅助药物分为4组:未使用活血化瘀辅助药物、使用1种活血化瘀辅助药物、使用2种活血化瘀辅助药物、使用≥3种活血化瘀辅助药物。收集患者的病史资料、治疗情况等基线数据,汇总活血化瘀类辅助药物使用情况,评估患者CRUSADE出血风险等级,并分析患者UGH发生频数。结果纳入ACS患者共503例,4组间既往病史、基础药物使用以及介入治疗频数之间无统计学差异。随着CRUSADE出血风险等级的递增,UGH发生率显著增加。极低危和低危出血风险的ACS患者,4组间的UGH发生率无显著性差异(P>0.05);中危与高危出血风险的ACS患者,使用2种与≥3种活血化瘀药患者的UGH发生率均明显高于未用活血化瘀药与使用1种活血化瘀药,差异有统计学意义,其他组之间无统计学差异;极高危出血风险的ACS患者,与使用1种活血化瘀药相比,使用2种与≥3种活血化瘀药患者的UGH发生率明显增加,P值分别为0.009,0.025(<0.05),有统计学差异。结论对于出血风险中危与高危的ACS患者,使用≥2种活血化瘀药会显著增加UGH风险;UGH发生率随着CRUSADE出血风险等级的递增而显著增加,对于极高危出血风险的ACS患者,更应严格控制活血化瘀药的使用。
Objective To analyze the use of adjuvant drugs for promoting blood circulation and removing blood stasis in patients with acute coronary syndrome (ACS) in our hospital and to investigate the effect of this type of drug on upper gastrointestinal haemorrhage (UGH). Reasonable application of blood circulation phlegm adjuvant drugs for reference. METHODS: Patients with ACS from May to July 2016 in our hospital were divided into 4 groups according to whether or not they used blood circulation and phlegm-removing adjuvants: no adjuvant therapy for activating blood circulation and removing blood stasis, 1 use of a blood circulation adjuvant, and use of 2 types of blood circulation瘀Assist drugs and use ≥3 kinds of adjuvant drugs to activate blood circulation. Baseline data, such as patient’s medical history data and treatment status, were collected to summarize the use of auxiliary drugs for promoting blood circulation and removing blood stasis. CRUSADE bleeding risk grades were assessed and the frequency of UGH was analyzed. Results A total of 503 patients with ACS were enrolled. There was no statistical difference between the previous medical history, the use of basic drugs, and the frequency of intervention. With the increasing risk level of CRUSADE bleeding, the incidence of UGH increased significantly. There was no significant difference in the incidence of UGH between the four groups in ACS patients with very low risk and low risk of bleeding (P>0.05). Two patients and ≥3 kinds of blood circulation and phlegm drugs were used in ACS patients with intermediate and high risk of bleeding. The incidence of UGH in patients was significantly higher than that of patients not receiving blood circulation and removing stasis drugs and using one type of blood circulation and stasis drugs. The difference was statistically significant. There was no statistical difference between the other groups; ACS patients with extremely high risk of hemorrhage and use 1 Compared with blood circulation and phlegm-reducing drugs, the incidence of UGH in patients with two or more than three kinds of blood circulation and phlegm-removing drugs was significantly increased, and the P values were 0.009 and 0.025 (<0.05), respectively. There was a statistically significant difference. Conclusion The use of ≥2 kinds of blood circulation expectorants in ACS patients with intermediate and high risk of bleeding may significantly increase the risk of UGH; the incidence of UGH increases significantly with the increasing risk level of CRUSADE bleeding. For patients with ACS who are at high risk of bleeding, More strictly control the use of blood circulation drugs.