CAJ | 학술논문

目的分析术前应用阿司匹林和氯吡格雷等抗血小板药物的策略对非体外循环冠状动脉旁路移植术(CABG)围术期的出血、输血和术后1个月并发症等的影响.方法选择2011年10月-2012年10月在北京安贞医院由同一组术者实施非体外循环CABG的患者480例进行回顾性分析,其中术前持续应用阿司匹林(至少停用氯吡格雷5d以上)的患者198例(阿司匹林组,组1),服用阿司匹林和氯吡格雷双联抗血小板药物至术前第3天的患者53例(阿司匹林+氯吡格雷组,组2),术前停用阿司匹林、氯吡格雷等抗血小板药物5d以上的患者229例(对照组,组3).比较3组的术中、术后失血量和输血量、二次开胸情况以及术后1个月内并发症等.结果 3组患者的基线临床资料差异无统计学意义(P＞0.05),术后胸腔引流量组2明显高于组1和组3[(827±216) ml与(416±135) ml、(265 ±85)ml,P＜0.05)],组1虽然高于组3但差异无统计学意义(P＞0.05),3组均无住院死亡、卒中及心肌梗死等相关并发症.结论 CABG术前停用氯吡格雷＜5d会增加术后失血量,术前应用阿司匹林不会明显增加围术期出血和并发症的发生.
목적 분석술전응용아사필림화록필격뢰등항혈소판약물적책략대비체외순배관상동맥방로이식술(CABG)위술기적출혈、수혈화술후1개월병발증등적영향.방법 선택2011년10월-2012년10월재북경안정의원유동일조술자실시비체외순배CABG적환자480례진행회고성분석,기중술전지속응용아사필림(지소정용록필격뢰5d이상)적환자198례(아사필림조,조1),복용아사필림화록필격뢰쌍련항혈소판약물지술전제3천적환자53례(아사필림+록필격뢰조,조2),술전정용아사필림、록필격뢰등항혈소판약물5d이상적환자229례(대조조,조3).비교3조적술중、술후실혈량화수혈량、이차개흉정황이급술후1개월내병발증등.결과 3조환자적기선림상자료차이무통계학의의(P＞0.05),술후흉강인류량조2명현고우조1화조3[(827±216) ml여(416±135) ml、(265 ±85)ml,P＜0.05)],조1수연고우조3단차이무통계학의의(P＞0.05),3조균무주원사망、졸중급심기경사등상관병발증.결론 CABG술전정용록필격뢰＜5d회증가술후실혈량,술전응용아사필림불회명현증가위술기출혈화병발증적발생.
Objective To analyze the effects of preoperative uses of aspirin and clopidogrel on perioperative blood loss and blood transfusion requirements and complication in patients undergoing off-pump coronary artery bypass graft (CABG).Methods At our hospital from October 2011 to October 2012,a total of 480 patients underwent off-pump CABG performed by the same surgical team.Among them,198 patients continued aspirin (discontinued clopodgrel at least 5 days) through operation (aspirin group,1),53 had aspirin and clopidogrel until 3 days before surgery (aspirin and clopidogrel group,2) and 229 discontinued antiplatelet therapy 5 more days before surgery (control group,3).Results No significant difference of basic clinical characteristics existed among three groups (P ＞ 0.05).Group 2 was associated with a greater volume of chest tube drainage than other groups (827 ± 216 vs 416 ± 135 vs 265 ± 85 ml,P ＜0.05).There was no significant difference between groups 1 and 3,even though chest tube drainage volume of group 1 was greater (827 ±216vs 265 ±85 ml,P ＞0.05).There was no instance of stroke,myocardial infarction or post-operative mortality.Conclusion Preoperative clopidogrel exposure within 5 days of surgery increases perioperative blood loss.And the pre-operative use of aspirin results in no difference in postoperative perioperative blood loss and cardiovascular outcomes.