冠状动脉搭桥术前服用阿司匹林对早期预后的影响

发布时间：2018-04-30 13:14

本文选题：阿司匹林 + 冠心病　；参考：《天津医科大学》2015年硕士论文

【摘要】：目的:分析冠心病患者OPCAB术前使用阿司匹林的风险和获益,并进一步分析阿司匹林在老年患者中的应用。方法:采用回顾性队列研究。选取2010年1月~2014年6月天津市胸科医院连续首次择期OPCAB手术病例。依据术前5天内使用阿司匹林情况分为两组,通过单因素和倾向指数回归分析方法比较两组患者术后住院期间预后的差异。进一步选取其中65岁以上患者,使用相同方法比较两组老年患者预后。通过对早期预后的比较,评价OPCAB患者术前使用阿司匹林的风险和获益。结果:总计纳入患者3531例,其中男性2564例,女性967例,平均年龄63.2(±8.5)岁。持续使用阿司匹林至术前5天内817例,术前停用阿司匹林5天及以上2714例。全组患者术后院内死亡29例。通过倾向指数回归分析,术前5天内服用阿司匹林与停药相比,住院期间全因死亡率(校正OR0.89,95%CI0.35-2.26,P=0.80)、术后心肌梗死(校正OR0.52,95%CI0.15-1.81,P=0.31)、脑血管意外(校正OR 1.06,95%CI0.32-3.49,P=0.93)、肾衰(校正OR0.86,,95%CI0.40-1.84,P=0.70)、血液透析(校正OR0.66,95%CI0.12-2.68,P=0.48),开胸止血(校正OR0.79,95%CI0.46-1.36,P=0.40),差异无统计学意义,而服用阿司匹林组术后输红细胞比例较高(校正OR1.39,95%CI1.16-1.66,P0.01)。老年患者(65岁)中,通过倾向指数回归分析,术前5天内服用阿司匹林与停药相比,住院期间全因死亡率(校正OR0.53,95%CI0.15-1.95,P=0.34)、术后心肌梗死(校正OR0.32,95%CI0.04-2.62,P=0.29)、脑血管意外(校正OR 1.30,95%CI0.24-6.91,P=0.76)、肾衰(校正OR0.53,,95%CI0.17-1.65,P=0.27)、血液透析(校正OR0.42,95%CI0.05-3.38,P=0.44),开胸止血(校正OR0.57,95%CI0.41-1.87,P0.01)差异无统计学意义,同样,服用阿司匹林组红细胞输血比例较高(校正OR1.50,95%CI1.13-2.00,P0.01)。结论:1.OPCAB术前5天内使用阿司匹林会增加红细胞输注,没有增加二次开胸止血的发生率。2.OPCAB术前5天内使用阿司匹林与术后早期死亡率、早期心肌梗死、脑血管意外、肾衰和透析等发生率无相关性。3.老年(65岁)患者OPCAB术前5天内使用阿司匹林会增加红细胞输注,没有增加二次开胸止血的发生率。4.老年(65岁)患者OPCAB术前5天内使用阿司匹林与术后早期死亡率、早期心肌梗死、脑血管意外、肾衰和血液透析等发生率无相关性。5.上述研究结论有待大规模随机对照临床试验进一步证实。
[Abstract]:Aim: to analyze the risk and benefit of aspirin use in patients with coronary heart disease (CHD) before OPCAB, and to further analyze the use of aspirin in elderly patients. Methods: retrospective cohort study was used. From January 2010 to June 2014, we selected the first consecutive elective OPCAB operation in Tianjin chest Hospital. The patients were divided into two groups according to the use of aspirin within 5 days before operation. The prognosis of the two groups during hospitalization was compared by univariate and tendency index regression analysis. Patients over 65 years of age were further selected to compare the prognosis of the two groups with the same method. To evaluate the risk and benefit of aspirin use in patients with OPCAB before operation by comparing early prognosis. Results: a total of 3531 patients were included, including 2564 males and 967 females, with an average age of 63.2 (卤8.5) years. There were 817 patients who continued to use aspirin for 5 days before operation and 2714 patients who stopped using aspirin for 5 days or more before operation. 29 patients died in hospital after operation. By regression analysis of propensity index, aspirin was taken within 5 days before operation compared with withdrawal. Total mortality rate during hospitalization (corrected OR0.8995 CI0.35-2.26 P0.80, postoperative myocardial infarction (corrected OR0.5295 CI 0.15-1.81 P0.31), cerebrovascular accident (OR 1.0695 CI 0.32-3.49 P0.93), renal failure (corrected OR0.8695 CI0.40-1.84P 0.70), hemodialysis (corrected OR0.6695CI0.12-2.68 Pnu 0.48), thoracotomy and hemostasis (corrected OR0.7995 CI0.46-1.36 P0.40), no statistical significance. In aspirin group, the ratio of red blood cell transfusion was higher (corrected OR 1.39 ~ 95CI 1.16-1.66C P 0.01). In elderly patients (65 years old), the tendency index regression analysis showed that aspirin intake within 5 days before operation was compared with withdrawal. Total mortality rate during hospitalization (adjusted OR0.5395 CI0.15-1.95CI0.34), postoperative myocardial infarction (corrected OR0.32m95 CI0.04-2.62P0.29, cerebrovascular accident (OR 1.3095 CI 0.24-6.91P0.76), renal failure (corrected OR0.5395CI0.17-1.65P0.27), hemodialysis (corrected OR0.4295CI5-3.38Pl 0.44), thoracotomy and hemostasis (corrected OR0.5795 CI0.41-1.87 P0.01) had no statistical significance, the same was true. The proportion of red blood cell transfusion was higher in aspirin group (corrected OR 1.50 ~ 95CI 1.13-2.00 P 0.01). Conclusion: 1. The use of aspirin within 5 days before OPCAB can increase the red blood cell infusion, but not the incidence of secondary thoracotomy and hemostasis. 2. Before OPCAB, aspirin use within 5 days before operation and early postoperative mortality, early myocardial infarction, cerebrovascular accident, and so on. There was no correlation between renal failure and dialysis. Aspirin increased erythrocyte infusion within 5 days before OPCAB, but did not increase the incidence of secondary thoracotomy hemostasis. There was no correlation between aspirin use and postoperative early mortality, early myocardial infarction, cerebrovascular accident, renal failure and hemodialysis. These conclusions need to be further confirmed in a large-scale randomized controlled clinical trial.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

【共引文献】