CAJ | 학술논문

目的评估术前持续应用氯吡格雷和术中应用氨甲环酸对体外循环冠状动脉旁路移植术(CABG)患者术后出血和异体输血的影响及其相互作用.方法采用2×2析因分析,第1个因素为术前抗血小板治疗,持续应用氯吡格雷至术前7天以内者纳入用药组(E组),未应用者纳入空白组(B组)；第2个因素为术中抗纤溶治疗,氨甲环酸为T组,空白对照为P组.333例择期CABG患者,氨甲环酸为麻醉诱导后给予负荷量10 mg/kg静脉滴注,继以维持量10 mg·kg-1· h-1持续静脉泵入直至手术结束.结果无论术前是否持续应用氯吡格雷,氨甲环酸都可显著降低术后出血量等指标(ET组对EP组,P＜0.01；BT组对BP组,P＜0.01).术前持续应用氯吡格雷可显著增加术后出血量(EP组对BP组,P＜0.05)、大出血发生比例和红细胞输注量(EP组对BP组,P＜0.01)、红细胞及血浆输注比例(EP组对BP组、P＜0.05)以及总输血比例(EP组对BP组,P＜0.01).术前持续应用氯吡格雷的患者接受氨甲环酸治疗后,所有出血和输血指标与术前未应用氯吡格雷者相似(ET组对BP组,P＜0.05).结论 CABG忠者术前持续应用氯吡格雷至术前7天以内可显著增加术后出血和异体输血,术中应用氨甲环酸可降低这一风险,并消除术前持续应用氯吡格雷对出血和输血的不良影响.
목적 평고술전지속응용록필격뢰화술중응용안갑배산대체외순배관상동맥방로이식술(CABG)환자술후출혈화이체수혈적영향급기상호작용.방법 채용2×2석인분석,제1개인소위술전항혈소판치료,지속응용록필격뢰지술전7천이내자납입용약조(E조),미응용자납입공백조(B조)；제2개인소위술중항섬용치료,안갑배산위T조,공백대조위P조.333례택기CABG환자,안갑배산위마취유도후급여부하량10 mg/kg정맥적주,계이유지량10 mg·kg-1· h-1지속정맥빙입직지수술결속.결과 무론술전시부지속응용록필격뢰,안갑배산도가현저강저술후출혈량등지표(ET조대EP조,P＜0.01；BT조대BP조,P＜0.01).술전지속응용록필격뢰가현저증가술후출혈량(EP조대BP조,P＜0.05)、대출혈발생비례화홍세포수주량(EP조대BP조,P＜0.01)、홍세포급혈장수주비례(EP조대BP조、P＜0.05)이급총수혈비례(EP조대BP조,P＜0.01).술전지속응용록필격뢰적환자접수안갑배산치료후,소유출혈화수혈지표여술전미응용록필격뢰자상사(ET조대BP조,P＜0.05).결론 CABG충자술전지속응용록필격뢰지술전7천이내가현저증가술후출혈화이체수혈,술중응용안갑배산가강저저일풍험,병소제술전지속응용록필격뢰대출혈화수혈적불량영향.
Objective To evaluate premature clopidogrel cessation,intraoperative tranexamic acid and their interaction on bleeding and transfusion outcomes in on-pump CABG patients.Methods The current study is a prospective and randomized trial with 2 × 2 factorial design.The first factor is preoperative clopidogrel with 2 levels,clopidogrel ingestion within 7 days preoperatively (group E) and nave to clopidogrel (group B).The second level is antifibrinolytic therapy with 2 level,tranexamic acid (group T) and placebo (group P).A total of 333 patients receiving selective on-pump CABG were recruited.The tranexamic acid regimen was a bolus of 10 mg · kg-1 followed by a maintenance of 10 mg · kg 1 · h-1 throughout the surgery.Results Baseline characteristics were fairly balanced among the groups.Tranexamic acid significantly reduced postoperative blood loss.major bleeding,the volume of erythrocyte and plasma transfused,the exposure of erythrocyte,plasma and any allogeneic products (ET vs EP,P ＜ 0.01 ; BT vs BP,P ＜ 0.01).Clopidogrel within 7 days preoperatively significantly increased blood loss (EP vs BP,P＜0.05),major bleeding,the volume of erythrocyte (EP vs BP,P＜0.01) and the exposure of erythrocyte and plasma (EP vs BP,P ＜ 0.05) and any allogeneic products (EP vs BP,P ＜ 0.01).Under the protection of tranexamic acid,the bleeding and transfusion outcomes were comparable between the patients with premature clopidogrel cessation and those nave to clopidogrel (ET vs BP,P ＞0.05).Perioperative mortality,morbidity and the incidence of adverse events were comparable among the groups except for IABP.Conclusion Comparing with nave to clopidogrel,premature cessation within 7 days preoperatively deteriorated bleeding and transfusion outcomes in on-pump CABG patients.Intraoperative tianexamie acid could reduce the risk.