围手术期口服阿司匹林对经尿道前列腺电切术出血的影响

发布时间：2018-01-25 21:15

本文关键词： 阿司匹林出血经尿道前列腺电切术　出处：《山东大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究背景由于阿司匹林具有抑制血小板聚集的作用,被广泛用于预防心脑血管疾病。大量证据证明阿司匹林能减少心血管死亡、心肌梗塞、不稳定心绞痛、中风、短暂性脑缺血风险。但是,围手术期服用阿司匹林具有增加手术出血风险的副作用。Shahar等估计大约有25%老年患者应当服用阿斯匹林,许多患者需终身服药。作为二级预防,停止阿斯匹林心肌梗塞和死亡有3倍增长(OR3.14),对冠脉支架置入患者风险增加90倍(OR89.87),2个独立的研究显示停用阿斯匹林发生心血管事件的平均时间是8.5到10.7天,接近于血小板的寿命。经尿道前列腺电切术(transurethral resection of prostate, Turp)是常见的泌尿外科手术,出血是其主要术后并发症。许多泌尿外科医师考虑围手术期服用阿司匹林,可能导致术后大量出血,因而要求所有患者围手术期停用阿司匹林。新近的调查显示绝大多数泌尿外科大夫认为,术前服用阿司匹林是经尿道前列腺电切术手术绝对禁忌症。现在心血管指南警告不要停止抗血小板药物,特别是患者有冠脉支架用抗血小板药物做二级预防的。然而,经尿道前列腺电切术患者的围手术期管理实际情况变化很大。患者服用华法林的情况相似。围手术期抗凝药或抗凝因子管理至今未达成共识。问题是围手术期应用抗凝药和抗血小板治疗增加出血,随后应用控制出血治疗而增加了血栓的风险和发病率。为此,本研究利用现有病案资料,总结了研究服用阿司匹林对经尿道前列腺电切术出血的影响,以期为经尿道前列腺电切术患者的围手术期是否应停用抗凝药提供科学依据。研究目的研究围手术期口服阿司匹林对经尿道前列腺电切术出血的影响。材料与方法研究对象来源于自2012年1月至2013年12月到高密市人民医院、胶州市中心医院、胶南市人民医院泌尿外科接受经尿道前列腺电切术的病人。所有资料为病历资料,本次研究共选取361例研究对象,根据研究对象既往围手术期阿司匹林服用情况,分为3组。1组：阿司匹林组(围手术期服用阿司匹林)50例,2组：停止服用组(术前10天及围手术期停止服阿司匹林)86例,3组：未服用阿司匹林或抗凝剂组225例。收集研究对象各项指标：研究对象一般特征：包括年龄、职业、经济收入(年)、医保类型、身高、体重。生活嗜好：是否吸烟、开始吸烟时间、每日吸烟量、是否饮酒、开始饮酒时间、饮酒种类、每日饮酒量。阿司匹林服用情况：是否服用阿司匹林,开始服用阿司匹林时间(年前)、阿司匹林每日服用量。研究对象其他疾病史：肝功能是否正常、是否高血压、血压值、心功能、血肌酐(数值)、是否肾积水、是否糖尿病、是否慢性肺阻塞性疾病、心梗史、是否使用其他抗凝血药物、脑血管意外史。前列腺增生情况及相关症状：病程(年)、是否膀胱结石、术前是否反复血尿、术前是否尿路感染、术前是否留置尿管、前列腺体积等。术中及术后指标：包括前列腺切除重量、手术时间、术中并发症、术中出血量、术后出血量、停止冲洗时间等。应用广义线性回归分析控制有关可能的混杂因素,探讨数值变量指标的影响因素。研究结果 1.对术中出血量影响因素的分析,单因素分析显示术中出血量与前列腺体积、前列腺切除重量、手术时间正相关,P0.0001；与术前反复血尿负相关,P0.05。多因素分析显示一直服药组与其他2组相比,术中出血量并无差异。 2.对术后出血量影响因素的分析,单因素分析显示术后出血量可能与家庭年收入负相关,p=0.0005；与前列腺体积、前列腺切除重量、手术时间、术中出血量、心功能障碍、是否留置尿管正相关,p值为＜0.0001、＜0.0001、＜0.0001、＜0.0001、＜0.0001、0.0117。多因素分析显示未曾服药组较一直服药组的术后出血量减少了67.3138m1,p＜0.0001,术前停药组较一直服药组的术后出血量减少了73.3138m1,p＜0.0001。 3.对停止冲洗时间影响因素的分析,单因素分析结果表明,停止冲洗时间可能与家庭年收入负相关,P0.01；与前列腺体积、前列腺切除重量、手术时间、术中出血量、术后出血量、是否存在心功能障碍正相关。多因素分析显示未曾服药组与一直服药组相比,停止冲洗时间并无差异；术前停药组与一直服药组相比,停止冲洗时间并无差异。结论行经尿道前列腺电切术病人,围手术期口服阿司匹林组与术前10天及围手术期停止服阿司匹林、未服用阿司匹林或抗凝剂两组相比,术中出血量和停止膀胱冲洗时间无明显差异,围手术期口服阿司匹林组与其它另组相比,术后出血量增多。建议因围手术期口服阿司匹林组术后增加的出血量无明显临床意义,考虑到服用阿司匹林对于预防心血管事件的收益,本人建议,行经尿道前列腺电切术时不用停服预防剂量阿司匹林。
[Abstract]:Research background
Because aspirin has inhibitory effect on platelet aggregation, is widely used in the prevention of cardiovascular and cerebrovascular diseases. A lot of evidence that aspirin reduces the risk of cardiovascular death, myocardial infarction, unstable angina, stroke, transient ischemic risk. However, perioperative use of aspirin can increase the side effects of.Shahar estimate the risk of surgical bleeding about 25% elderly patients should take aspirin, many patients need lifelong medication. As the two level prevention of myocardial infarction and stop aspirin 3 times growth death (OR3.14), coronary stent implantation in patients with increased risk of 90 times (OR89.87), 2 independent research shows that the average time of discontinuation of aspirin for cardiovascular events is 8.5 to 10.7 days and close to the platelet life.
Transurethral resection of the prostate (transurethral resection of prostate, Turp) is a common operation in the Department of Urology, hemorrhage was the main postoperative complications. Many perioperative Department of Urology physicians consider taking aspirin, may lead to massive bleeding after operation, it is required that the patients with perioperative aspirin withdrawal. Recent research showed that the majority of doctor in the Department of Urology that preoperative aspirin is transurethral resection of the prostate surgery contraindication.
Now the guide warned stop antiplatelet drugs for cardiovascular patients, especially with the two grade prevention of coronary stents with antiplatelet drugs. However, transurethral resection of the prostate in patients with perioperative management actual situation changed greatly. Similar patients taking warfarin. Perioperative anticoagulation or anticoagulant management has not reached a consensus. The problem is the application of perioperative anticoagulation and antiplatelet therapy increased bleeding, followed by treatment of bleeding control increased the risk of thrombosis and the incidence of the disease.
Therefore, the present study summarized the effect of aspirin on bleeding after transurethral resection of prostate, based on existing medical records, in order to provide a scientific basis for perioperative use of anticoagulants in patients undergoing transurethral resection of prostate.
research objective
To investigate the effect of perioperative oral aspirin on the bleeding of the transurethral resection of the prostate.
Materials and methods
The subjects were from January 2012 to December 2013, who received transurethral resection of the prostate in Gaomi City people's Hospital, Jiaozhou Central Hospital and Department of Urology of Jiaonan people's hospital.
All the information for the medical records, this study selected 361 cases of the research object, according to the situation of taking aspirin study included perioperative period, divided into 3 groups:.1 group and aspirin group (perioperative aspirin) in 50 cases, 2 groups: stop taking group (10 days before surgery and perioperative stop aspirin) in 86 cases, 3 groups: not taking aspirin or anticoagulants group 225 cases.
Collect the target of the research object:
The general features of the study include age, occupation, economic income (year), type of medical insurance, height and weight.
Life habits: smoking, starting time of smoking, daily smoking, drinking, starting time of drinking, type of drinking, and daily alcohol consumption.
Take aspirin: take aspirin, start taking aspirin (a year ago) and take the daily dose of aspirin.
Other disease history of the subjects: liver function, hypertension, blood pressure, heart function, serum creatinine (numerical value), hydronephrosis, diabetes mellitus, chronic obstructive pulmonary disease, history of myocardial infarction, use of other anticoagulant drugs, and cerebrovascular accident history.
Benign prostatic hyperplasia and related symptoms: duration (year), bladder stone, preoperative hematuria, preoperative urinary tract infection, preoperative indwelling catheter, prostate volume, etc.
Intraoperative and postoperative indicators include the weight of prostatectomy, operation time, intraoperative complications, intraoperative bleeding, postoperative bleeding, and time to stop flushing.
The generalized linear regression analysis is used to control the possible confounding factors and to discuss the influence factors of the index of numerical variables.
Research results
1. on the analysis of the factors that affect the amount of intraoperative bleeding, univariate analysis showed that the amount of bleeding and prostate volume, prostate gland weight, positive correlation, operation time and preoperative P0.0001; recurrent hematuria negative correlation, P0.05. regression analysis showed that the treatment group has been compared with the other 2 groups, the amount of intraoperative bleeding did not differ.
2. on the analysis of the factors that affect the amount of postoperative bleeding, univariate analysis showed that postoperative bleeding may be related to family income are negatively related to p=0.0005; resection of the prostate and prostate volume, weight, operation time, blood loss, intraoperative cardiac dysfunction, whether indwelling catheter is related to p value < 0.0001, < < 0.0001. 0.0001, < 0.0001, < 0.0001,0.0117. multivariate analysis showed that no medication group than the drug group had postoperative bleeding reduced 67.3138m1, P < 0.0001, preoperative discontinuation group than the drug group have postoperative bleeding reduced 73.3138m1, P < 0.0001.
3. to stop washing analysis of risk factors of time, the results of univariate analysis showed that the flushing time may stop and family income are negatively related to P0.01; resection of the prostate and prostate volume, weight, operation time, intraoperative bleeding, postoperative bleeding volume, the existence of heart dysfunction is related. Multivariate analysis showed no the drug group compared with the treatment group has no difference, stop the flushing time; preoperative discontinuation group and medication group has been compared, stop the flushing time no difference.
conclusion
Transurethral resection of the prostate patient, around the 10 day oral aspirin group and surgery and perioperative period before stopping aspirin, not taking aspirin or anticoagulants compared to the two groups, the amount of intraoperative bleeding and stop bladder irrigation time had no significant difference in perioperative oral aspirin group compared with other groups. Increase the amount of bleeding after operation.
proposal
There was no significant clinical significance in the increase of bleeding volume in the oral aspirin group during the perioperative period. Taking into account the benefits of aspirin to prevent cardiovascular events, I suggested that aspirin should not be stopped during transurethral resection of the prostate.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R699.8

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