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目的:探讨幽门螺杆菌根除治疗对长期应用阿司匹林和氯吡格雷3个月以上患者上消化道再出血的影响。方法:将160例上消化道出血伴有长期服用阿司匹林和氯吡格雷患者,给予埃索美拉唑治疗。经胃黏膜组织吉姆萨染色病理检查和快速尿素酶试验后,114例患者幽门螺杆菌感染阳性为阳性组,剩余的46例为阴性组。按照随机数字表将阳性组分为观察组(57例)与对照组(57例)。给予观察组幽门螺杆菌根除治疗,并采用14 C呼气试验检查幽门螺杆菌根除情况。3组患者完成治疗后随访6个月,观察患者再出血等临床情况。结果:3组各有1例患者失访。观察组患者均获得根除幽门螺杆菌。3组再出血病因主要是出血性胃炎和消化性溃疡。意向性分析中,观察组的再出血率显著低于对照组(8.8%,5/57 vs 31.6%,18/57),χ2=9.205,P<0.05;阴性组(19.6%,9/46)与观察组、对照组之间均无显著差异,P>0.05。符合方案集分析中,观察组的再出血率显著低于对照组(8.9%,5/56 vs 32.1%,18/56),χ2=9.247,P<0.01;阴性组(20.0%,9/45)与观察组、对照组之间均无显著差异,P>0.05。结论:幽门螺杆菌根除治疗能够有效降低长期应用阿司匹林和氯吡格雷3个月以上患者上消化道再出血的发生率。
Objective: To investigate the effect of Helicobacter pylori eradication on long-term use of aspirin and clopidogrel in patients over three months of upper gastrointestinal rebleeding. Methods: 160 patients with upper gastrointestinal bleeding accompanied by long-term use of aspirin and clopidogrel were given esomeprazole treatment. After gastric mucosa Giemsa staining and rapid urease test, 114 patients were positive for Helicobacter pylori infection, and the remaining 46 patients were negative. According to the random number table, the positive components were observed group (57 cases) and control group (57 cases). The observation group was given H. pylori eradication treatment and H. pylori eradication was examined by 14 C breath test. Three groups of patients were followed up for 6 months after completion of treatment, and observed the clinical situation of rebleeding. Results: One patient in each of the three groups was lost. Observation group patients were eradicated Helicobacter pylori. The main causes of rebleeding in group 3 were hemorrhagic gastritis and peptic ulcer. In the intention analysis, the rebleeding rate in the observation group was significantly lower than that in the control group (8.8%, 5/57 vs 31.6%, 18/57), χ2 = 9.205, P <0.05; negative group (19.6%, 9/46) There was no significant difference between the observation group and the control group, P> 0.05. According to the protocol set analysis, the rebleeding rate in the observation group was significantly lower than that in the control group (8.9%, 5/56 vs 32.1%, 18/56), χ2 = 9.247, P <0.01; negative group (20.0%, 9/45 ) And observation group and control group no significant difference, P> 0.05. Conclusion: Helicobacter pylori eradication therapy can effectively reduce the incidence of upper gastrointestinal rebleeding in long-term aspirin and clopidogrel 3 months or more.