术前持续双联血小板治疗对非体外循环下冠状动脉旁路移植术近期预后的影响

发布时间：2018-05-28 12:48

本文选题：非体外循环 + 冠状动脉旁路移植术　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的评估术前持续服用阿司匹林和氯吡格雷的双联抗血小板治疗(Dual Antiplatelet Therapy,DAPT)对非体外循环下冠状动脉旁路移植术(Off-Pump Coronary Artery Bypass Grafting,OPCABG)患者近期预后的影响。方法本研究为单中心观察性研究。纳入279例2015年1月至2016年5月期间在天津市胸科医院进行初次单纯非体外循环下心脏不停跳冠状动脉旁路移植术的患者,按照术前双联抗血小板治疗(DAPT)情况将其分成两组:一组患者持续DAPT至术前1天DAPT组(n=148);另一组患者OPCABG术前停用DAPT5天(对照组,n=131)。搜集两组患者基线资料,术后总引流量、出血剖胸探查发生率、血制品输注以及其他住院期间的临床结果资料进行比较和统计学分析。结果两组患者人口学特征和临床基线资料无显著差异。DAPT组患者在术后总的胸腔引流量(DAPT组vs.对照组,899±227 m L vs.801±242 m L,P=0.001)和围术期血制品输注(包括输血比例和输血量)上都明显高于对照组。两组患者术后出血所致剖胸探查发生率(DAPT组vs.对照组,3.4%vs.0.8%,P=0.219),手术时间(DAPT组vs.对照组,4.93±0.69 vs.4.82±0.69,P=0.168),ICU停留时间(DAPT组vs.对照组,51.82±13.95 h vs.50.56±13.04 h,P=0.434),气管内插管时间(DAPT组vs.对照组,16.23±2.57 h vs.16.12±2.61 h,P=0.729),术后住院天数(DAPT组vs.对照组,10.6±5.4 d vs.9.6±4.8 d,P=0.108),术后非致死性心肌梗死发生率(DAPT组vs.对照组,4.7%vs.3.8%,P=0.708)均无明显统计学差异。术后住院期间未观察到卒中和其他严重的胸外出血,两组患者术后住院期间均无死亡病例。结论OPCABG患者术前持续服用双联抗血小板治疗会增加术后胸腔引流液和血制品输注需求但不具有显著临床意义。双联抗血小板治疗持续至术前不增加出血剖胸探查发生率,不影响OPCABG患者的近期预后和术后恢复。如果临床情况许可,拟行初次单纯OPCABG的患者术前持续服用双联抗血小板药物是安全的。这一抗血小板治疗方案的长期临床结果则需要更大样本的多中心随机对照试验进一步评估。
[Abstract]:Objective to evaluate the effect of dual antiplatelet therapy with aspirin and clopidogrel on the short term prognosis of Off-Pump Coronary Artery Bypass grafting (OPCABG) patients after off-pump coronary artery bypass grafting (CABG). Methods this study was a monocentric observational study. From January 2015 to May 2016, 279 patients underwent coronary artery bypass grafting (CABG) at Tianjin chest Hospital for the first time without cardiopulmonary bypass. According to the condition of dual antiplatelet therapy before operation, the patients were divided into two groups: one group was treated with DAPT until one day before operation, and the other group with OPCABG was stopped for DAPT5 day before operation (control group). The baseline data of the two groups, the total drainage, the incidence of bleeding thoracotomy, the blood product infusion and other clinical data during hospitalization were compared and statistically analyzed. Results there was no significant difference in demographic characteristics and clinical baseline data between the two groups. In the control group (899 卤227ml vs.801 卤242ml) and perioperative transfusion of blood products (including blood transfusion ratio and transfusion volume) were significantly higher than those in the control group. The incidence of thoracotomy caused by postoperative bleeding in both groups was higher than that in DAPT group. The control group (3.4vs.0.8vs 0.219g) and the DAPT group (Vs0.219g). The control group (4.93 卤0.69 vs.4.82 卤0.69 vs.4.82 卤0.168 vs.4.82) and the DAPT group had a time of stay in ICU. The control group was 51.82 卤13.95 h vs.50.56 卤13.04 h, the endotracheal intubation time of DAPT group was 0.434.The time of endotracheal intubation in DAPT group was higher than that in DAPT group. The control group was 16.23 卤2.57h vs.16.12 卤2.61h, and the days of postoperative hospitalization were significantly higher than that of DAPT group (vs). The control group was 10.6 卤5.4d vs.9.6 卤4.8dPU 0.108g, and the incidence of postoperative non-fatal myocardial infarction was higher than that of DAPT group. There was no significant difference between the control group (4.7vs.3.8) and the control group (0.708). No stroke or other severe extrathoracic hemorrhage was observed during hospitalization, and there were no death cases in both groups. Conclusion continuous administration of dual antiplatelet therapy before operation in patients with OPCABG may increase the need for postoperative pleural drainage and transfusion of blood products, but it has no significant clinical significance. Dual antiplatelet therapy did not increase the incidence of bleeding thoracotomy before operation, and did not affect the short-term prognosis and postoperative recovery of patients with OPCABG. If clinical conditions permit, it is safe for first-time OPCABG patients to continue to take dual antiplatelet drugs before operation. The long-term clinical results of this anti-platelet regimen require further evaluation in a larger sample of multicenter randomized controlled trials.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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