目的 運(yùn)用CRUSADE評分系統(tǒng)，探討質(zhì)子泵抑制劑在預(yù)防經(jīng)皮冠狀動脈介入治療（PCI）術(shù)后消化道出血中的價值。方法 前瞻性納入華北醫(yī)療健康集團(tuán)峰峰總醫(yī)院心內(nèi)科2018年3月-2021年12月收治的接受支架植入治療的冠心病患者600例，依據(jù)CRUSADE評分系統(tǒng)的危險分層，把極低危、低危的歸為低危分層組，中危、高危、很高危的歸為中高危組，各危險分層按1∶1比例隨機(jī)分為對照組與試驗(yàn)組，各組患者在PCI術(shù)前、術(shù)后均給予阿司匹林腸溶片、硫酸氫氯吡格雷片口服，試驗(yàn)組在此基礎(chǔ)上給予聯(lián)合質(zhì)子泵抑制劑（雷貝拉唑腸溶片每天20 mg或泮托拉唑鈉腸溶片每天40 mg）自PCI術(shù)前至術(shù)后連續(xù)服藥3個月。隨訪12個月，觀察各組患者消化道出血事件以及主要心腦血管不良事件發(fā)生情況。結(jié)果 根據(jù)CRUSADE評分的不同，中高危分層對照組較低危分層對照組的消化道出血事件明顯增加，差異有統(tǒng)計學(xué)意義（P＜0.05）。同時，與低危分層對照組相比，低危分層試驗(yàn)組消化道出血事件發(fā)生率未見明顯差異（P＞0.05）。中高危分層試驗(yàn)組消化道出血事件發(fā)生率較中高危分層對照組明顯減少，差異有統(tǒng)計學(xué)意義（P＜0.05）。在同一類CRUSADE評分系統(tǒng)危險分層中，試驗(yàn)組和對照組患者主要心腦血管不良事件發(fā)生率未見明顯差異（P＞0.05）。結(jié)論 應(yīng)用CRUSADE評分系統(tǒng)進(jìn)行危險分層，干預(yù)出血高危風(fēng)險患者，PCI術(shù)后加用質(zhì)子泵抑制劑可有效預(yù)防消化道出血，且未增加心腦血管不良事件風(fēng)險。

Objective To explore the value of proton pump inhibitors in the prevention of gastrointestinal bleeding after percutaneous coronary intervention (PCI) using CRUSADE scoring system. Methods Prospectively included 600 patients with coronary heart disease who received stent implantation treatment in the Department of Cardiology, Fengfeng General Hospital, North China Medical and Health Group from March 2018 to December 2021. According to the risk stratification of the CRUSADE scoring system, the extremely low risk and low risk patients were classified into low risk stratification group, the medium risk, high risk and very high risk patients were classified into medium high risk group, and each risk stratification was randomly divided into control group and test group according to the ratio of 1∶ 1. The patients in each group were divided into two groups before PCI After the operation, aspirin and clopidogrel were given orally. On this basis, the test group was given a combined proton pump inhibitor (rabeprazole 20 mg per day or pantoprazole 40 mg per day) for 3 months from the pre-operation to the post-operation. Follow up for 12 months, and observe the occurrence of gastrointestinal bleeding events and major cardiovascular and cerebrovascular adverse events in each group. Results According to the different CRUSADE scores, the incidence of gastrointestinal bleeding in the middle-high risk stratified control group was significantly higher than that in the low-risk stratified control group (P< 0.05). At the same time, compared with the low-risk stratified control group, there was no significant difference in the incidence of gastrointestinal bleeding events in the low-risk stratified test group (P> 0.05). The incidence of gastrointestinal bleeding in the middle and high risk stratified test group was significantly lower than that in the middle and high risk stratified control group (P< 0.05). In the risk stratification of the same CRUSADE scoring system, there was no significant difference in the incidence of major cardiovascular and cerebrovascular adverse events between the test group and the control group (P> 0.05). Conclusion The use of CRUSADE scoring system for risk stratification, intervention of high-risk patients with bleeding, and the use of proton pump inhibitors after PCI can effectively prevent gastrointestinal bleeding without increasing the risk of cardiovascular and cerebrovascular adverse events.

R975