同期行冠状动脉搭桥术合并瓣膜置换术患者平均血小板体积与术后异常引流的相关分析

发布时间：2018-04-13 06:04

本文选题：平均血小板体积 + 冠状动脉搭桥术　；参考：《南京医科大学学报(自然科学版)》2017年08期

【摘要】：目的 :研究同期行冠状动脉搭桥术合并瓣膜置换术患者的平均血小板体积(mean platelet volume,MPV)水平与术后抗凝治疗所致异常引流的关系,为术后抗凝治疗方案提供依据。方法:回顾性分析需同期行冠状动脉搭桥术合并瓣膜置换术患者共72例,收集临床资料,根据术后5 d内总引流量的P75及抗凝相关出血事件将患者分为2组。结果:术前MPV和术前血小板计数呈负相关(r=-0.511,P0.001),与术后引流量呈正相关(r=0.300,P=0.013)。组2中患者的年龄、饮酒史、生物瓣膜使用率、术后血小板使用量均高于组1,术前MPV水平高于组1,术后血小板计数低于组1(均P0.05)。年龄、合并饮酒史、术前MPV是患者术后异常引流的独立危险因素。术前MPV水平绘制受试者工作特征曲线(ROC曲线),曲线下面积(AUC)为0.691,(95%CI0.553~0.829,P=0.012),最佳截点10.75 fl,敏感性0.714,特异性0.617。结论 :同期行冠状动脉搭桥术合并瓣膜置换术的患者,术前MPV水平与术后抗凝治疗导致的异常引流具有明显相关性,且具很好的独立预测价值。对于术前MPV大于10.75 fl、高龄、合并饮酒史、置换生物瓣的患者,术后抗凝治疗应该谨慎,并注意凝血功能的监测。
[Abstract]:Aim: to study the relationship between mean platelet volume MPV (mean platelet volume MPV) and postoperative anticoagulant drainage in patients undergoing coronary artery bypass grafting (CABG) combined with valve replacement, and to provide evidence for postoperative anticoagulant therapy.Methods: the clinical data of 72 patients undergoing coronary artery bypass grafting combined with valve replacement were retrospectively analyzed. The patients were divided into two groups according to the total drainage P75 and the anticoagulation-related bleeding events within 5 days after operation.Results: there was a negative correlation between preoperative MPV and preoperative platelet count, and there was a positive correlation between preoperative MPV and postoperative drainage.In group 2, the patients' age, drinking history, biovalvular utilization rate and platelet use rate after operation were all higher than those in group 1, the MPV level before operation was higher than that in group 1, and the platelet count after operation was lower than that in group 1 (all P 0.05).Age, history of drinking and preoperative MPV were independent risk factors for postoperative abnormal drainage.Before operation, the operating characteristic curve of subjects was drawn by MPV level. The area under the curve was 0. 691and 0. 691and 0. 553C0. 829p0. 012. the best cut-off point was 10. 75fl. the sensitivity was 0. 714 and the specificity was 0. 617.Conclusion: the preoperative MPV level in patients undergoing coronary artery bypass grafting combined with valve replacement is significantly correlated with the postoperative abnormal drainage caused by anticoagulant therapy and has a good independent predictive value.For patients with preoperative MPV greater than 10.75fl, old age, history of alcohol consumption, and biological flap replacement, postoperative anticoagulant therapy should be careful, and the monitoring of coagulation function should be paid attention to.
【作者单位】：南京医科大学第一附属医院心脏大血管外科;
【基金】：国家自然科学基金(81573234)
【分类号】：R654.2

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