中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
13期
5767-5771
,共5页
吴文波%吴明营%周自强%齐弘炜%崔华楠%王妍军%赵建刚%陈楠
吳文波%吳明營%週自彊%齊弘煒%崔華楠%王妍軍%趙建剛%陳楠
오문파%오명영%주자강%제홍위%최화남%왕연군%조건강%진남
冠状动脉旁路移植术,非体外循环%阿司匹林%剂量效应关系,药物%血小板聚集抑制剂
冠狀動脈徬路移植術,非體外循環%阿司匹林%劑量效應關繫,藥物%血小闆聚集抑製劑
관상동맥방로이식술,비체외순배%아사필림%제량효응관계,약물%혈소판취집억제제
Coronary artery bypass,off-pump%Aspirin%Dose-response relationship,drug%Platelet aggregation inhibitors
目的：应用血栓弹力图（TEG）评价非体外循环下冠状动脉旁路移植（OPCAB）术后早期（14 d内）100 mg/d和200 mg/d阿司匹林治疗下血小板聚集抑制率（ INHAA）及获得性阿司匹林抵抗（ AR）的发生率，探讨增加阿司匹林剂量对术后早期获得性AR的影响。方法前瞻性连续选取行OPCAB术的患者60例，按术后服用阿司匹林剂量的不同随机分为两组：阿司匹林200 mg组、阿司匹林100 mg组，分别于停药前（Ta）、手术前（Tb）、术后应用阿司匹林治疗后6 h（T1）、第5天（T2）、第14天（T3）进行TEG血小板功能检测。结果术后T1、T2时200 mg组 INHAA显著高于100 mg 组（ P ＜0.05）， T3时两组差异不显著（ P＞0.05）。 T1时AR发生率200 mg组显著低于100 mg组（P＜0.05），T2、T3时AR发生率两组差异不显著（P＞0.05）。结论 OPCAB术后早期（14 d内）200 mg/d阿司匹林抗血小板治疗可以增加INHAA，减少获得性AR的发生率，有益于术后早期抗血小板治疗。
目的：應用血栓彈力圖（TEG）評價非體外循環下冠狀動脈徬路移植（OPCAB）術後早期（14 d內）100 mg/d和200 mg/d阿司匹林治療下血小闆聚集抑製率（ INHAA）及穫得性阿司匹林牴抗（ AR）的髮生率，探討增加阿司匹林劑量對術後早期穫得性AR的影響。方法前瞻性連續選取行OPCAB術的患者60例，按術後服用阿司匹林劑量的不同隨機分為兩組：阿司匹林200 mg組、阿司匹林100 mg組，分彆于停藥前（Ta）、手術前（Tb）、術後應用阿司匹林治療後6 h（T1）、第5天（T2）、第14天（T3）進行TEG血小闆功能檢測。結果術後T1、T2時200 mg組 INHAA顯著高于100 mg 組（ P ＜0.05）， T3時兩組差異不顯著（ P＞0.05）。 T1時AR髮生率200 mg組顯著低于100 mg組（P＜0.05），T2、T3時AR髮生率兩組差異不顯著（P＞0.05）。結論 OPCAB術後早期（14 d內）200 mg/d阿司匹林抗血小闆治療可以增加INHAA，減少穫得性AR的髮生率，有益于術後早期抗血小闆治療。
목적：응용혈전탄력도（TEG）평개비체외순배하관상동맥방로이식（OPCAB）술후조기（14 d내）100 mg/d화200 mg/d아사필림치료하혈소판취집억제솔（ INHAA）급획득성아사필림저항（ AR）적발생솔，탐토증가아사필림제량대술후조기획득성AR적영향。방법전첨성련속선취행OPCAB술적환자60례，안술후복용아사필림제량적불동수궤분위량조：아사필림200 mg조、아사필림100 mg조，분별우정약전（Ta）、수술전（Tb）、술후응용아사필림치료후6 h（T1）、제5천（T2）、제14천（T3）진행TEG혈소판공능검측。결과술후T1、T2시200 mg조 INHAA현저고우100 mg 조（ P ＜0.05）， T3시량조차이불현저（ P＞0.05）。 T1시AR발생솔200 mg조현저저우100 mg조（P＜0.05），T2、T3시AR발생솔량조차이불현저（P＞0.05）。결론 OPCAB술후조기（14 d내）200 mg/d아사필림항혈소판치료가이증가INHAA，감소획득성AR적발생솔，유익우술후조기항혈소판치료。
Objective To compare the AA-induced inhibition rate ( INHAA) of platelet and incidences of aspirin resistance of patients undergoing OPCAB surgery who are receiving two different doses of aspirin (200 mg/d vs.100 mg/d)within the early postoperative period (14 days),explore the impact of additional dose of aspirin on aspirin resistance .Methods 60 patients underwent OPCAB surgery were randomly divided into two groups ( The 100 mg-group and the 200 mg-group) according to their aspirin dosages of postoperative antiplatelet therapy .INHAA were measured and calculated by thrombelastography ( TEG ) at different time points:Ta ( the day before aspirin was withdrew),Tb(pre-operation),T1(6 hours after first application of aspirin after OPCAB),T2(the 5th day of aspirin therapy),T3(the 14th day of aspirin therapy).Results INHAA was significantly increased in patients in 200 mg-group than those in 100 mg-group at T1 and T2(P<0.05),INHAA at T3 was not significantly different between the two groups ( P>0.05 ) .Incidence of AR was significantly reduced in patients in 200 mg-group than those in 100 mg-group at T1.Incidence of AR at T2 and T3 was not significantly different within the two groups ( P >0.05 ). Conclusion Additional dose of aspirin has positive effect on increasing INHAA , reducing the acquired aspirin resistance and improving the efficacy of antiplatelet therapy in early postoperative time ( within 14 days postoperation ) .
