冠心病高危左主干病变的外科治疗策略

发布时间：2018-06-27 13:12

本文选题：左主干病变 + 冠脉搭桥术　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:评价冠脉高危左主干病变患者施行非体外循环冠脉搭桥术术前应用抗血小板药物对术后出血、输血及并发症的影响。方法:选取河北医科大学第二医院心脏大血管外科2015年至2016年期间行非体外循环冠脉搭桥术的115例冠脉高危左主干病变患者,依据中止双联抗血小板治疗(阿司匹林+氯吡格雷)的时间,将患者分为术前停药5d及5d以上组(A组)、术前停药3~4d组(B组)、术前停药1d组(C组)以及服药至术日组(D组)。比较四组患者术后胸腔引流量、输血量、不良心血管事件(急性心梗、死亡)、二次开胸等情况。结果:1四组患者的基线资料包括年龄、性别、身高、体重、高血压病史、高脂血症病史、糖尿病病史、左室射血分数、血红蛋白、血小板计数等差异无统计学意义(P0.05)。2四组患者手术时间、急性心梗发生率、二次开胸发生率、住院死亡率差异无统计学意义(P0.05)。术后24h引流量和术后总引流量有统计学意义(P0.05)。术后24h引流量C组和D组明显高于A组[(596.82±412.682)vs.(611.18±210.745)vs.(403.76±116.073)mL,P0.05],B组虽然高于A组,但差异无统计学意义(P0.05)。术后总引流量也是C组和D组明显高于A组,差异有统计学意义(P0.05)。3四组患者输血浆比例和输血浆量差异无统计学意义(P0.05)。四组患者均未输血小板。C组和D组对红细胞的需求量明显高于A组,差异有统计学意义(P0.05)。D组对冷沉淀的需求量明显高于A组,差异有统计学意义(P0.05)。结论:非体外循环冠脉搭桥术术前5d内继续应用双联抗血小板药物,会增加术后引流量及输血量,但不增加严重出血风险及术后早期死亡率。对于拟行非体外循环冠脉搭桥术的冠脉高危左主干病变患者,应该综合考虑患者实际情况,必要时可缩短停药时间。
[Abstract]:Objective: to evaluate the effects of antiplatelet drugs on postoperative bleeding, blood transfusion and complications in patients with high risk left main coronary artery disease after off-pump coronary artery bypass grafting. Methods: 115 patients with high risk coronary artery disease underwent off-pump coronary artery bypass grafting from 2015 to 2016 in Cardiovascular macrovascular surgery, second Hospital of Hebei Medical University. According to the time of discontinuation of dual antiplatelet therapy (clopidogrel aspirin), the patients were divided into three groups: group A (group A), group B (group B), group C (group C) and group D (group D). Chest drainage, blood transfusion, adverse cardiovascular events (acute myocardial infarction, death) and secondary thoracotomy were compared among the four groups. Results the baseline data of the four groups included age, sex, height, weight, history of hypertension, history of hyperlipidemia, history of diabetes, left ventricular ejection fraction, hemoglobin. There was no significant difference in platelet count (P0.05). 2 the time of operation, the incidence of acute myocardial infarction, the incidence of secondary thoracotomy, and the mortality rate of hospitalization were not significantly different among the four groups (P0.05). Postoperative 24 hours drainage volume and postoperative total drainage flow were statistically significant (P0.05). 24 hours after operation, the drainage volume in group C and group D was significantly higher than that in group A [(596.82 卤412.682) vs. (, 611.18 卤210.745) vs. (, 403.76 卤116.073) vs. (, P0.05] although group B was higher than group A, the difference was not statistically significant (P0.05). Postoperative total drainage volume was significantly higher in group C and group D than in group A (P0.05). There was no significant difference in the proportion and volume of plasma transfusion among the four groups (P0.05). The demand for erythrocyte in group C and D was significantly higher than that in group A (P0.05). The demand for cryoprecipitation in group D was significantly higher than that in group A (P0.05). Conclusion: continuous use of dual antiplatelet drugs within 5 days before off-pump coronary artery bypass grafting can increase postoperative drainage volume and blood transfusion volume, but does not increase the risk of severe bleeding and early postoperative mortality. For patients with high risk left main coronary artery disease undergoing off-pump coronary artery bypass grafting, the actual situation of the patients should be considered comprehensively and the withdrawal time should be shortened if necessary.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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