河北医药
河北醫藥
하북의약
HEBEI MEDICAL JOURNAL
2014年
10期
1445-1448
,共4页
李波%顾承雄%杨俊峰%韦华%李京悻%刘锐%黄信生%李晖%李琴%李海涛
李波%顧承雄%楊俊峰%韋華%李京悻%劉銳%黃信生%李暉%李琴%李海濤
리파%고승웅%양준봉%위화%리경행%류예%황신생%리휘%리금%리해도
冠脉搭桥术%氯吡格雷%左冠脉主干狭窄
冠脈搭橋術%氯吡格雷%左冠脈主榦狹窄
관맥탑교술%록필격뢰%좌관맥주간협착
coronary artery bypass grafting%clopidogrel%Left main coronary artery stenosis
目的：评价左冠脉主干狭窄患者择期非体外循环冠脉搭桥手术术前在应用低分子肝素的基础上合用氯吡格雷的安全性及有效性。方法对228例左冠脉主干病变施行择期非体外循环冠脉搭桥的患者进行回顾性分析。根据术前5 d内是否停用氯吡格雷，将患者分为双联抗栓组及单纯应用低分子肝素组。比较2组患者术前不良心血管事件的发生（死亡、不稳定心绞痛、急性心肌梗死）、主动脉球囊反搏使用，及术后出血的发生情况。结果双联抗栓组术前不良心血管事件发生率显著低于低分子肝素组，前者术后出血量和输血量略多于后者，但2组之间主动脉球囊反搏使用、术后消化道出血、脑出血、开胸止血发生率、正性肌力药的使用、监护时间差异无统计学意义（P ＞0构．05）。结论对于左冠脉主干狭窄拟行择期CABG术患者，在应用低分子肝素抗凝的基础上，术前5d内继续应用氯吡格雷与降低术前心血管事件呈相关性，且不增加严重出血风险。
目的：評價左冠脈主榦狹窄患者擇期非體外循環冠脈搭橋手術術前在應用低分子肝素的基礎上閤用氯吡格雷的安全性及有效性。方法對228例左冠脈主榦病變施行擇期非體外循環冠脈搭橋的患者進行迴顧性分析。根據術前5 d內是否停用氯吡格雷，將患者分為雙聯抗栓組及單純應用低分子肝素組。比較2組患者術前不良心血管事件的髮生（死亡、不穩定心絞痛、急性心肌梗死）、主動脈毬囊反搏使用，及術後齣血的髮生情況。結果雙聯抗栓組術前不良心血管事件髮生率顯著低于低分子肝素組，前者術後齣血量和輸血量略多于後者，但2組之間主動脈毬囊反搏使用、術後消化道齣血、腦齣血、開胸止血髮生率、正性肌力藥的使用、鑑護時間差異無統計學意義（P ＞0構．05）。結論對于左冠脈主榦狹窄擬行擇期CABG術患者，在應用低分子肝素抗凝的基礎上，術前5d內繼續應用氯吡格雷與降低術前心血管事件呈相關性，且不增加嚴重齣血風險。
목적：평개좌관맥주간협착환자택기비체외순배관맥탑교수술술전재응용저분자간소적기출상합용록필격뢰적안전성급유효성。방법대228례좌관맥주간병변시행택기비체외순배관맥탑교적환자진행회고성분석。근거술전5 d내시부정용록필격뢰，장환자분위쌍련항전조급단순응용저분자간소조。비교2조환자술전불양심혈관사건적발생（사망、불은정심교통、급성심기경사）、주동맥구낭반박사용，급술후출혈적발생정황。결과쌍련항전조술전불양심혈관사건발생솔현저저우저분자간소조，전자술후출혈량화수혈량략다우후자，단2조지간주동맥구낭반박사용、술후소화도출혈、뇌출혈、개흉지혈발생솔、정성기력약적사용、감호시간차이무통계학의의（P ＞0구．05）。결론대우좌관맥주간협착의행택기CABG술환자，재응용저분자간소항응적기출상，술전5d내계속응용록필격뢰여강저술전심혈관사건정상관성，차불증가엄중출혈풍험。
Objective To evaluate the safety and effect of applying LMWH ( low molecular weight heparin ) with clopidogrel before elective off-pump coronary artery bypass grafting in left main disease .Methods Retrospective analysis of the 228 patients of left main coronary stenosis cases undertaking elective off-pump coronary bypass grafting .All patients were divided into clopidogrel group ( combined with LMWH ) and pure LMWH group ( applying LMWH only ) .Compare the adverse cardiovascular events ( death,unstable angina pectoris ,acute myocardial infarction ) ,and the post operation hemorrhage in both groups.Results In clopidogrel group,the occurrence rate of adverse cardiovascular events was remarkably lower ,while the postoperative bleeding amount and transfusion amount were a little more than those in LMWH group .There were no obvious differences on intra-aortic balloon pump using ,gastrointestinal bleeding ,cerebral hemorrhage ,thoracotomy hemostasis rate ,the using of positive inotropic drug and the staying time in ICU .Conclusion Compared with merely applying LMWH ,combined applying clopidogrel with LMWH 5 days before elective off-pump coronary bypass grafting can relatively reduce preoperative adverse cardiovascular events in patients of left main coronary stenosis and do not increase the serious bleeding complication .
