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目的评价接受 PCI 的患者术后住院期间合并上消化道出血(UGH)的发生率、影响因素及转归。方法选择2002年9月至2006年3月接受 PCI 的2279例冠心病患者,其中21例患者PCI 后发生 UGH,分析所有患者的临床特点及预后,讨论影响 UGH 发生的预测因素。结果年龄≥70岁、女性、合并糖尿病、消化性溃疡病史、以急性冠状动脉综合征入院的患者 UGH 发生率较高;PCI术中应用血小板糖蛋白Ⅱb/Ⅲa受体拈抗剂以及接受急诊 PCI 的患者 UGH 发生率相对较高;发生UGH 的患者住院期间及随访6个月总的主要心脑血管不良事件(死亡、心肌梗死、靶血管重建、脑卒中)发生率显著高于未发生 UGH 的患者(23.0%比9.3%,P<0.01);发生 UGH 的患者平均住院时间明显延长(13.8 d 比5.1 d,P<0.001);年龄≥70岁[比值比(OR)值2.23,95%可信区间(CI)1.01～4.13,P<0.01]、以急性冠状动脉综合征入院(OR 值1.91,95% CI 0.57～2.52,P<0.05)以及消化性溃疡病史(OR 值1.02,95% CI 0.17～2.25,P<0.05)是 PCI 患者术后住院期间发生 UGH 的预测因素。结论接受 PCI 的患者住院期间 UGH 发生率为0.92%,年龄≥70岁、以急性冠状动脉综合征入院及消化性溃疡病史是发生 UGH 的预测因素,合并 UGH 的患者住院及6个月随访主要不良心脑血管事件发生率增加。
Objective To evaluate the incidence, influencing factors and outcome of postoperative hospitalized patients with upper gastrointestinal bleeding (UGH) who underwent PCI. Methods A total of 2279 patients with coronary artery disease undergoing PCI from September 2002 to March 2006 were selected. Among them, UGH occurred in 21 patients after PCI. The clinical features and prognosis of all patients were analyzed. The predictors of UGH occurrence were also discussed. Results The age of 70 years or older, female patients with diabetes mellitus and history of peptic ulcer had a higher prevalence of UGH in patients admitted to hospital with acute coronary syndrome. In patients undergoing PCI, platelet glycoprotein Ⅱb / Ⅲa receptor antagonist and emergency PCI Of patients with UGH relatively higher incidence of UGH patients were hospitalized and 6 months of follow-up of the total major cardiovascular and cerebrovascular adverse events (death, myocardial infarction, target revascularization, stroke) was significantly higher than the incidence of non-UGH (23.0% vs 9.3%, P <0.01). The average length of hospital stay in patients with UGH was significantly longer (13.8 days vs 5.1 days, P <0.001); odds ratio (OR) was 2.23 and 95% (OR = 1.91, 95% CI 0.57-2.52, P <0.05), and the history of peptic ulcer (OR 1.02, 95% CI, CI = 1.01-4.13, P 0.01) 0.17 ~ 2.25, P <0.05) were the predictors of postoperative UGH in patients with PCI. Conclusions The incidence of UGH during hospitalization in patients receiving PCI is 0.92%, and the age is over 70 years old. The admission of patients with acute coronary syndrome and the history of peptic ulcer are the predictors of the occurrence of UGH. The patients with UGH were hospitalized and the major adverse events at 6 months follow-up The incidence of cardiovascular and cerebrovascular events increased.