术前长期服用阿司匹林对神经外科择期手术的影响

发布时间：2018-03-13 11:40

本文选题：阿司匹林　切入点：神经外科　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:阿司匹林作为血小板聚集抑制剂,目前已广泛用于预防中老年人的心脑血管疾病。然而,近来研究显示,阿司匹林具有导致出血的潜在风险,能增加自发性颅内出血危险性,是出血后近期死亡的独立预测指标,那么,术前长期服用阿司匹林可能增加颅脑手术术后颅内出血的风险。本研究的目的是:探讨术前长期服用阿司匹林对中老年患者颅脑外科择期手术术后颅内出血等的影响,为改进临床工作提供参考。方法:收集吉林大学第一医院神经肿瘤外科2016年1月至2016年9月583例患者,对患者病史、影像学资料、手术记录、术后病程进行回顾性分析。按照纳入标准,最后171例患者作为研究对象。将未服用阿司匹林的患者列为对照组,长期服用阿司匹林的患者列为实验组。主要对长期口服阿司匹林药物史、术前凝血常规及血小板凝集功能检查、术后CT检测是否出血及出血量、死亡率及出院时日常生活活动能力(ADL)分级、住院天数及术前、术后3天血红蛋白含量等进行分析。实验组在复查血小板凝集功能正常后实施手术。最后收集两组患者术后出血、术后血红蛋白含量、死亡率、出院时日常生活活动能力(ADL)分级、住院天数、术前及术后3天血红蛋白含量情况,并采用SPSS 22.0进行统计学分析。结果:对照组(术前未服用阿司匹林)共143例,男性患者55例(32.2%),平均年龄为(56.4?6.7)岁,女性患者88例(51.2%),平均年龄(55.7?6.2)岁。实验组(术前服用阿司匹林超过1个月)共28例,男性患者12例(7.0%),平均年龄为(61.8?6.5)岁,女性患者16例(9.4%),平均年龄为(60.6?5.4)岁。研究结果表明,两组患者术后出血率无统计学意义(T=-0.160,P=0.8730.05)。两组患者出院时ADL评分无统计学意义(Z=-1.934,P=0.0530.05)。两组患者的死亡率均为0%。两组患者术前与术后3天血红蛋白含量差值具有统计学意义(T=-3.499,P=0.010.05),表明术前长期服用阿司匹林的患者术后有隐性失血。术前长期服用阿司匹林的患者住院天数明显长于未服用阿司匹林的患者(T=-1.981,P=0.490.05)。结论:1.术前长期服用阿司匹林的神经外科择期手术的患者,待其血小板凝集功能恢复正常后进行手术,手术出血率及出院时ADL评分与未服用阿司匹林的患者无统计学意义。2,术前长期服用阿司匹林的神经外科择期手术的患者,待其血小板凝集功能恢复正常后实施手术,隐性失血及住院天数均比未服用阿司匹林的患者增多。
[Abstract]:Objective: aspirin, as an inhibitor of platelet aggregation, has been widely used to prevent cardiovascular and cerebrovascular diseases in middle-aged and elderly people. However, recent studies have shown that aspirin has the potential to cause bleeding. It can increase the risk of spontaneous intracranial hemorrhage and is an independent predictor of short-term mortality after hemorrhage. The aim of this study was to investigate the effect of long-term aspirin on intracranial hemorrhage after selective craniocerebral surgery in middle-aged and elderly patients before and after craniocerebral surgery. Methods: from January 2016 to September 2016, we collected 583 patients from the Department of Neurooncology, the first Hospital of Jilin University. The course of the disease was analyzed retrospectively. According to the inclusion criteria, 171 patients were included in the study. The patients who did not take aspirin were included as the control group. The patients who took aspirin for a long time were included in the experimental group. The patients were given long-term oral aspirin drug history, blood coagulation routine before operation and platelet agglutination function examination, and CT examination after operation was used to detect bleeding and bleeding volume. The mortality and ADL grade, the days of hospitalization and the hemoglobin content before operation and 3 days after operation were analyzed. The patients in the experimental group were operated on after checking the platelet agglutination function. Finally, the patients in the two groups received postoperative bleeding. Hemoglobin content, mortality rate, ADL grade at discharge, hospitalization days, hemoglobin content before and 3 days after operation, SPSS 22.0 was used for statistical analysis. Results: there were 143 cases in control group (without aspirin before operation) and 55 cases in male patients (mean age was 56.4? 6. 7 years old, 88 cases of female patients with 51.2%, mean age of 55.7? 6. 2 years old. There were 28 patients in the experimental group (taking aspirin for more than 1 month before operation) and 12 male patients (mean age was 61.8? 6.5 years old, 16 female patients with an average age of 60.6? 5.4 years of age. The results of the study show that. There was no significant difference in postoperative bleeding rate between the two groups. There was no significant difference in ADL score at discharge between the two groups. The mortality rate of both groups was 0. The difference of hemoglobin content between preoperative and postoperative 3 days was statistically significant. The results showed that the patients who had taken aspirin for a long time before operation had recessive blood loss after operation. The days of hospitalization of the patients who took aspirin for a long time before operation were significantly longer than that of patients without aspirin. Conclusion: 1. Patients undergoing elective neurosurgery, When the platelet agglutination function returned to normal, the bleeding rate and the ADL score at discharge had no significant difference with those of the patients without aspirin, and the patients who had taken aspirin for a long time before operation were selected for neurosurgery. When the platelet agglutination function returned to normal, the recessive blood loss and hospitalization days were more than those without aspirin.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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