【摘要】 目的分析急性冠状动脉综合征合并肾功能不全患者出血的危险因素,为减少此类患者出血提供一定的参考。方法收集本院心血管内科2018年1月—2019年12月行经皮冠状动脉介入治疗术(percutaneous coronary intervention,PCI)且应用双联抗血小板治疗的201例急性冠状动脉综合征合并肾功能不全患者的临床资料,根据术后服用药物治疗过程中是否出血的情况分为非出血组(133例)和出血组(68例),并对两组的临床数据进行单因素分析及多因素Logistic回归分析。结果单因素分析表明,年龄、收缩压、肾小球滤过率、P2Y12抑制剂种类、冠状动脉旁路移植术(coronary artery bypass grafting,CABG)手术史、糖尿病、高血脂、术前血小板计数、白细胞、术后血小板计数、三酰甘油(TG)水平与出血相关。Logistic回归分析显示,患者的肾小球滤过率、年龄、收缩压、P2Y12受体抑制剂种类及CABG手术史是导致PCI术后应用双联抗血小板药物治疗出血的危险因素。结论急性冠状动脉综合征合并肾功能不全患者在PCI术后使用双联抗血小板药物治疗时,替格瑞洛会增加患者出血并发症的风险,应根据患者的年龄、收缩压、手术史情况,对P2Y12抑制剂进行风险评定,选择最佳的给药方案。更多还原

【Abstract】 Objective To determine the risk factors of bleeding in patients with acute coronary syndrome and renal insufficiency,and to provide reference for reducing bleeding in such patients.Methods The clinical data of 201 patients with acute coronary syndrome and renal insufficiency who underwent percutaneous coronary intervention (PCI) and received dual antiplatelet therapy from January 2018 to December 2019 in the Department of Cardiovasology of the First Affiliated Hospital of Xi’an Jiaotong University were collected.Among them,133 were included in the non-bleeding group while the rest 68 were in the bleeding group according to whether bleeding occurred during the postoperative medication.The univariate and multivariate Logistic regression was performed.Results Univariate analysis showed that age,systolic blood pressure,glomerular filtration rate (GFR),P2Y12 inhibitor type,coronary artery bypass grafting (CABG),diabetes,hyperlipidemia,preoperative platelet count,white blood cells,postoperative platelet count and triglyceride (TG) were related to level bleeding.Logistic regression analysis showed that GFR,age,systolic blood pressure,P2Y12 inhibitor type,and CABG were risk factors for the use of dual antiplatelet drugs for bleeding after the PCI.Conclusion In patients with acute coronary syndrome and renal insufficiency receiving dual antiplatelet treatment after the PCI,ticagrelor may increase the risk of bleeding complications.The risk should be assessed of P2Y12 inhibitors,and best dosing regimen selected based on the age,history of surgery,and systolic blood pressure of patients.更多还原