中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2011年
8期
477-479
,共3页
王赞鑫%高菲%任静%门剑龙%魏民新
王讚鑫%高菲%任靜%門劍龍%魏民新
왕찬흠%고비%임정%문검룡%위민신
阿司匹林%冠状动脉旁路移植术%非体外循环%血小板聚集%血栓烷B2
阿司匹林%冠狀動脈徬路移植術%非體外循環%血小闆聚集%血栓烷B2
아사필림%관상동맥방로이식술%비체외순배%혈소판취집%혈전완B2
Aspirin%Coronary artery bypass graft off-pump%Platelet aggregation%Thromboxane B2
目的 通过检测非体外循环冠状动脉旁路移植术(OPCAB)后患者血小板聚集率以及尿11-脱氢-血栓烷B2(11-DH-TXB2)指标，动态观察术后阿司匹林抵抗(AR)的发生情况，探索术后AR的危险因素。方法 冠心病患者290例，首次行OPCAB患者145例(手术组)，接受内科药物治疗患者145例(非手术组)。手术组患者于术前及术后服用阿司匹林后第1、4、10天及6个月，检测血小板聚集率以及尿11-DH-TXB2。非手术组患者于服药前及服药后第1、4、10天检测上述指标。同时记录患者各项临床资料。结果 手术组患者服用阿司匹林后第1天的AR发生46例(32％)(抵抗组)，其余为非抵抗组。用药后第4天和第10天AR患者下降至19例(13％)和5例(3％)。半年随访中未发现有AR患者存在。非手术组患者，服药后第1天，血小板聚集率均下降至20％以下，平均(8.8±6.8)％，未见AR现象出现。手术组患者术后血小板计数显著高于术前(P＜0.05)。Logistic回归分析发现，OPCAB患者中，体重大于75 kg(OR =0.38，95％CI:0.18～0.79)和术后引流量超过500 ml(OR=3.12，95％CI:1.29～7.53)为术后出现AR的危险因素。结论 OPCAB术后早期，阿司匹林的抗血小板作用受到不同程度抑制，部分患者出现AR现象，予以更为积极有效的抗血小板治疗有重要临床意义。
目的 通過檢測非體外循環冠狀動脈徬路移植術(OPCAB)後患者血小闆聚集率以及尿11-脫氫-血栓烷B2(11-DH-TXB2)指標，動態觀察術後阿司匹林牴抗(AR)的髮生情況，探索術後AR的危險因素。方法 冠心病患者290例，首次行OPCAB患者145例(手術組)，接受內科藥物治療患者145例(非手術組)。手術組患者于術前及術後服用阿司匹林後第1、4、10天及6箇月，檢測血小闆聚集率以及尿11-DH-TXB2。非手術組患者于服藥前及服藥後第1、4、10天檢測上述指標。同時記錄患者各項臨床資料。結果 手術組患者服用阿司匹林後第1天的AR髮生46例(32％)(牴抗組)，其餘為非牴抗組。用藥後第4天和第10天AR患者下降至19例(13％)和5例(3％)。半年隨訪中未髮現有AR患者存在。非手術組患者，服藥後第1天，血小闆聚集率均下降至20％以下，平均(8.8±6.8)％，未見AR現象齣現。手術組患者術後血小闆計數顯著高于術前(P＜0.05)。Logistic迴歸分析髮現，OPCAB患者中，體重大于75 kg(OR =0.38，95％CI:0.18～0.79)和術後引流量超過500 ml(OR=3.12，95％CI:1.29～7.53)為術後齣現AR的危險因素。結論 OPCAB術後早期，阿司匹林的抗血小闆作用受到不同程度抑製，部分患者齣現AR現象，予以更為積極有效的抗血小闆治療有重要臨床意義。
목적 통과검측비체외순배관상동맥방로이식술(OPCAB)후환자혈소판취집솔이급뇨11-탈경-혈전완B2(11-DH-TXB2)지표，동태관찰술후아사필림저항(AR)적발생정황，탐색술후AR적위험인소。방법 관심병환자290례，수차행OPCAB환자145례(수술조)，접수내과약물치료환자145례(비수술조)。수술조환자우술전급술후복용아사필림후제1、4、10천급6개월，검측혈소판취집솔이급뇨11-DH-TXB2。비수술조환자우복약전급복약후제1、4、10천검측상술지표。동시기록환자각항림상자료。결과 수술조환자복용아사필림후제1천적AR발생46례(32％)(저항조)，기여위비저항조。용약후제4천화제10천AR환자하강지19례(13％)화5례(3％)。반년수방중미발현유AR환자존재。비수술조환자，복약후제1천，혈소판취집솔균하강지20％이하，평균(8.8±6.8)％，미견AR현상출현。수술조환자술후혈소판계수현저고우술전(P＜0.05)。Logistic회귀분석발현，OPCAB환자중，체중대우75 kg(OR =0.38，95％CI:0.18～0.79)화술후인류량초과500 ml(OR=3.12，95％CI:1.29～7.53)위술후출현AR적위험인소。결론 OPCAB술후조기，아사필림적항혈소판작용수도불동정도억제，부분환자출현AR현상，여이경위적겁유효적항혈소판치료유중요림상의의。
Objective The present study was designed evaluate the aspirin effectiveness in the inhibition of platelet aggregation in patients after OPCAB.Methods 290 patients were recruited.145 patients underwent first time OPCAB (surgery group).Arachidonic acid induced platelet aggregation and urine 11-dehydro thromboxane B2 (11-dehydroTxB2) were measured before operation and on aspirin re-administered days 1,4, 10, and 6 months after surgery.The same tests were also detected in 145 patients from the cardiology department (non-surgery group) received medicine therapy as controls.Results Ninety-nine patients were defined as aspirin sensitive after OPCAB (AS Group).Postoperative aspirin resistance was identified in 46 (32％) patients at the first day after aspirin treatment started (AR Group).19 (13％) and 5 (3％) patients remained as AR at day 4 and 10 after aspirin re-administration, respectively.Patients in the AR group had higher 11-dehydroTxB2 levels than those in the AS group (P = 0.049).Six months follow-up showed ARA-induced platelet aggregation was (11.5 ± 3.4) ％.Urine level of 11-dehydroTxB2 was (50.3 ± 15.4) ng/L.No resistance was found.All cardiologic patients were identified as aspirin sensitive, the change of platelet aggregation and 11-dehydroTxB2 were similar as those in the AS group.Weight ＞75 kg and postoperative drainage ＞500 ml were risk factors of aspirin resistance after OPCAB.Conclusion Anti-platelet effect of aspirin was reduced during the early postoperative period in certain patients undergoing OPCAB.In case of resistance,antiplatelet treatment strategy should be intensified or modified.
