未停用双联抗血小板药物治疗（DAPT）冠心病患者行非体外循环冠脉搭桥术（OPCABG）的安全性研究
发布时间：2019-06-12 06:42
【摘要】：目前,随着社会人口老龄化日益加剧,人们饮食结构的逐渐改变,生活水平的逐渐提升,心血管疾病已成为威胁大众生命安全的重大隐患,而急性冠脉综合征又是心血管疾病中最危急也是最威胁人们生命安全的。随着外科技术的逐渐成熟,冠状动脉旁路移植术(coronary artery bypass grafting,CABG)和心导管介入治疗已被广泛应用于治疗急性冠脉综合征和严重慢性冠状动脉粥样硬化。鉴于非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting,OPCABG)对于减少体外循环并发症以及缩短手术时间上都有明显的优势,对患者的预后有积极的作用,所以非体外循环冠状动脉旁路移植术(OPCABG)越来越被各大医院所认可,成为临床外科治疗冠心病的主要方式。目的:通过对双联抗血小板药物治疗(DAPT)冠心病患者行非体外循环冠状动脉旁路移植术(OPCABG)围术期各项指标的观察,对术前未常规停用DAPT冠心病患者围术期的安全性进行评估。从而为行急诊冠脉搭桥术患者提供更安全的围术期指导,并为其安全带来更有力的理论支持。方法:研究对象选择2014年11月~2017年1月在河北医科大学第二医院心脏外科行OPCABG的患者200例,按照其术前是否停用双联抗血小板药物一周以上分为对照组(N组)及观察组(B组),持续监测并记录患者从入室到出室的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、BIS值、心率(HR)及中心静脉压(CVP)等相关血流动力学参数;记录两组术中及术后出血及输血以及患者转归指标,并对各项指标进行统计,最终得出结论。结果：1 N组与B组在年龄、身高及各项基础生命体征上的差异无统计学意义(P0.05)。2 N组与B组从入室到出室的各个时间点的相关血流动力学指标的差异无统计学意义(P0.05)。3 N组与B组的术中出血量分别为(758.00±476.06)ml和(1016.55±597.98)ml,组间对比有统计学意义(P0.05)。4 N组与B组的术中自体血回输血量分别为(407.53±224.43)ml和(548.67±310.55)ml,组间对比有统计学意义(P0.05)。5 N组与B组的术后引流量分别为(337.15±162.01)ml和(393.75±211.42)ml,组间对比有统计学意义(P0.05)。6 N组与B组术后清醒时间,拔管时间,术后ICU停留时间,住院时间组间对比没有统计学差异(P0.05)。7 N组与B组术中输入异体血量(RBC,血浆,冷沉淀)差异有统计学意义(P0.05)。8 N组与B组的术中输入异体血的比率除冷沉淀有差异有统计学意义(P0.05)外,RBC与血浆差异均无统计学意义(P0.05)。9 N组与B组术后输入异体血量中冷沉淀以及血小板差异无统计学意义(P0.05),而RBC与血浆差异有统计学意义(P0.05)。10 N组与B组术后输入异体血的比率与输入血量相同,冷沉淀以及血小板差异没有统计学意义,而RBC与血浆差异有统计学意义(P0.05)。结论：1未停用双联抗血小板药物治疗(DAPT)冠心病患者行非体外循环冠脉搭桥术(OPCABG)相较于术前停用DAPT冠心病患者,术中出血量、术中输血率有明显增加,为术中管理增加了难度,但是术中血流动力学参数相较对照组,没有明显差异,说明DAPT冠心病患者术中完全可以保证患者生命体征的平稳。2未停用双联抗血小板药物治疗(DAPT)冠心病患者行非体外循环冠脉搭桥术(OPCABG)相较于术前停用DAPT冠心病患者而言,术后引流量及术后输血率也有所增加,为临床对其术后管理提供了依据。3未停用双联抗血小板药物治疗(DAPT)冠心病患者行非体外循环冠脉搭桥术(OPCABG)相较于术前停用DAPT冠心病患者而言,ICU停留时间以及住院时间并未有明显延长,故而为日后急诊行冠脉搭桥术的患者的安全性提供了有力的理论依据。
[Abstract]:At present, as the population aging is increasing, people's diet structure gradually changes, the living standard gradually increases, the cardiovascular disease has become a major hidden danger to the life safety of the public, Acute coronary syndrome, in turn, is the most critical of cardiovascular disease and is the most dangerous for people. With the gradual maturation of surgical techniques, coronary artery bypass grafting (CABG) and cardiac catheterization have been widely used in the treatment of acute coronary syndrome and severe chronic coronary atherosclerosis. In view of the significant advantages of off-pump coronary artery bypass grafting (OPCABG) in reducing the complications of cardiopulmonary bypass and shortening the time of operation, the prognosis of patients has a positive effect on the prognosis of patients. Therefore, the off-pump coronary artery bypass grafting (OPCABG) is more and more accepted by the major hospitals, and has become the main way of clinical surgery in the treatment of coronary heart disease. Objective: To evaluate the perioperative safety of DAPT coronary artery bypass grafting (OPCABG) in patients with coronary artery bypass grafting (DAPT) coronary artery bypass grafting (OPCABG) in patients with coronary heart disease (DAPT). So as to provide more safe perioperative guidance for patients with emergency coronary artery bypass surgery and provide more powerful theoretical support for the safety of the patients. Methods:200 patients with OPCABG in the second hospital of Hebei Medical University from November 2014 to January 2017 were selected and divided into the control group (N group) and the observation group (group B) according to whether the double antiplatelet drugs were used for more than a week before the operation. The relevant hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), BIS value, heart rate (HR) and central venous pressure (CVP) of the patient from the chamber to the outlet chamber were continuously monitored and recorded, and the two groups were recorded and post-operative bleeding and blood transfusion and the patient outcome index, And the indexes are counted, and finally the conclusions are finally drawn. Results: The age of the 1N and the B groups, There was no significant difference between the height and the basic vital signs (P0.05). There was no significant difference between the two groups (P0.05). The amount of blood loss in the 3 N and B groups was (758.00, 476.06) ml and (1016.55, 597.98) ml, respectively. There was a significant difference between the group and group B (P0.05). The amount of blood transfusion in the 4 N and B groups was (407.53, 224.43) ml and (548.67, 310.55) ml, respectively, and there was a significant difference between the groups (P0.05). The postoperative drainage rates of the 5N and group B groups were (337.15-162.01) ml and (393.75-211.42) ml, respectively. There was no statistical difference between the group and group B (P0.05). There was no statistical difference between group B and group B after operation (P0.05). The amount of allogenic blood (RBC, plasma, The difference of cold precipitation was statistically significant (P0.05). There was a significant difference in the ratio of blood to cold precipitation in the group of 8N and group B (P0.05). There was no significant difference between RBC and plasma (P0.05). There was no significant difference in the difference of RBC and plasma (P0.05). The difference of RBC and plasma was significant (P0.05). The ratio of input blood to blood in group 10N and group B was the same as that of the input blood. There was no statistical significance between cold precipitation and platelet difference, and the difference of RBC and plasma was significant (P0.05). Conclusion:1 The patients with coronary heart disease (DAPT) with coronary heart disease (DAPT) with coronary heart disease (DAPT) with coronary artery bypass (OPCABG) were treated with no-pump coronary artery bypass (OPCABG). but the hemodynamic parameters in the operation were not significantly different compared to the control group, The treatment of DAPT coronary heart disease (DAPT) with coronary artery bypass (OPCABG) in patients with coronary heart disease (DAPT) was not stopped and the patients with DAPT coronary heart disease were discontinued before operation. The postoperative drainage and post-operative blood transfusion rate were also increased, which provided a basis for the postoperative management of patients with coronary heart disease (DAPT). The stay time of the ICU and the hospital stay time were not significantly prolonged, thus providing a strong theoretical basis for the safety of the patients who underwent coronary artery bypass surgery in the future.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2
本文编号：2497817
[Abstract]:At present, as the population aging is increasing, people's diet structure gradually changes, the living standard gradually increases, the cardiovascular disease has become a major hidden danger to the life safety of the public, Acute coronary syndrome, in turn, is the most critical of cardiovascular disease and is the most dangerous for people. With the gradual maturation of surgical techniques, coronary artery bypass grafting (CABG) and cardiac catheterization have been widely used in the treatment of acute coronary syndrome and severe chronic coronary atherosclerosis. In view of the significant advantages of off-pump coronary artery bypass grafting (OPCABG) in reducing the complications of cardiopulmonary bypass and shortening the time of operation, the prognosis of patients has a positive effect on the prognosis of patients. Therefore, the off-pump coronary artery bypass grafting (OPCABG) is more and more accepted by the major hospitals, and has become the main way of clinical surgery in the treatment of coronary heart disease. Objective: To evaluate the perioperative safety of DAPT coronary artery bypass grafting (OPCABG) in patients with coronary artery bypass grafting (DAPT) coronary artery bypass grafting (OPCABG) in patients with coronary heart disease (DAPT). So as to provide more safe perioperative guidance for patients with emergency coronary artery bypass surgery and provide more powerful theoretical support for the safety of the patients. Methods:200 patients with OPCABG in the second hospital of Hebei Medical University from November 2014 to January 2017 were selected and divided into the control group (N group) and the observation group (group B) according to whether the double antiplatelet drugs were used for more than a week before the operation. The relevant hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), BIS value, heart rate (HR) and central venous pressure (CVP) of the patient from the chamber to the outlet chamber were continuously monitored and recorded, and the two groups were recorded and post-operative bleeding and blood transfusion and the patient outcome index, And the indexes are counted, and finally the conclusions are finally drawn. Results: The age of the 1N and the B groups, There was no significant difference between the height and the basic vital signs (P0.05). There was no significant difference between the two groups (P0.05). The amount of blood loss in the 3 N and B groups was (758.00, 476.06) ml and (1016.55, 597.98) ml, respectively. There was a significant difference between the group and group B (P0.05). The amount of blood transfusion in the 4 N and B groups was (407.53, 224.43) ml and (548.67, 310.55) ml, respectively, and there was a significant difference between the groups (P0.05). The postoperative drainage rates of the 5N and group B groups were (337.15-162.01) ml and (393.75-211.42) ml, respectively. There was no statistical difference between the group and group B (P0.05). There was no statistical difference between group B and group B after operation (P0.05). The amount of allogenic blood (RBC, plasma, The difference of cold precipitation was statistically significant (P0.05). There was a significant difference in the ratio of blood to cold precipitation in the group of 8N and group B (P0.05). There was no significant difference between RBC and plasma (P0.05). There was no significant difference in the difference of RBC and plasma (P0.05). The difference of RBC and plasma was significant (P0.05). The ratio of input blood to blood in group 10N and group B was the same as that of the input blood. There was no statistical significance between cold precipitation and platelet difference, and the difference of RBC and plasma was significant (P0.05). Conclusion:1 The patients with coronary heart disease (DAPT) with coronary heart disease (DAPT) with coronary heart disease (DAPT) with coronary artery bypass (OPCABG) were treated with no-pump coronary artery bypass (OPCABG). but the hemodynamic parameters in the operation were not significantly different compared to the control group, The treatment of DAPT coronary heart disease (DAPT) with coronary artery bypass (OPCABG) in patients with coronary heart disease (DAPT) was not stopped and the patients with DAPT coronary heart disease were discontinued before operation. The postoperative drainage and post-operative blood transfusion rate were also increased, which provided a basis for the postoperative management of patients with coronary heart disease (DAPT). The stay time of the ICU and the hospital stay time were not significantly prolonged, thus providing a strong theoretical basis for the safety of the patients who underwent coronary artery bypass surgery in the future.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2
【参考文献】
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1 罗将来;胡丽娜;;凝血功能检测在妊娠期糖尿病孕妇中的意义[J];重庆医学;2016年09期
2 张娟娟;王少华;虞文魁;石佳靓;沈娟红;高涛;习丰产;李宁;;猪创伤失血性休克模型凝血功能的变化[J];中华急诊医学杂志;2015年05期
3 赵海涛;李亮;蔡勤芳;田冶;曹福羊;;右美托咪啶对非体外循环冠状动脉旁路移植术中心肌保护的影响[J];中国临床医生;2014年03期
4 刘宝瑛;简奕婪;钟梅;余艳红;王前;张军;;妊娠晚期糖尿病孕妇止凝血功能指标检测的临床意义[J];南方医科大学学报;2007年01期
5 金沐;李书闻;卢家凯;程卫平;;男性患者非体外循环冠状动脉旁路移植术中心室颤动危险因素分析[J];中国医药;2013年08期
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