抗血小板治疗对非体外循环冠状动脉旁路移植术患者围手术期出血的影响

Effects of antiplatelet therapy on perioperative bleeding in patients undergoing off-pump coronary artery bypass grafting

关键词:  非体外循环  冠状动脉旁路移植术  阿司匹林  氯吡格雷  出血

Key words:  off-pump  coronary artery bypass grafting  aspirin  clopidogrel  blooding

摘要:

目的探讨抗血小板药物治疗对非体外循环冠状动脉旁路移植术（offpumpcoronaryarterybypassgrafting，OPCABG）围手术期出血的影响。方法回顾性总结分析611例择期OPCABG患者临床资料，分为服药组（Y组）466例和未服药组（N组）145例。服药组又分为：阿司匹林组（A组）94例和阿司匹林＋氯吡格雷组（AC组）372例。记录各组临床资料；分析比较各组术中失血量，术后胸腔引流量、血液制品使用率和使用量。多元线性回归模型分析与手术失血相关的因素。结果术中血浆用量Y组比N组少[（584．65±322．81）mlVS（681．47±359．38）ml，P：0．006]，两组在其他方面差异无统计学意义。服药组中，与AC组相比，A组手术时间短[（257．02±41．84）minVS（273．49±60．48）min，P=0．002]，近段吻合口数多（1．76±0．48VS1．58±0．60，P=0．002），红细胞使用率低（90．4％VS96．5％，P=0．013），血小板使用率低（4．3％VS15．6％，P=0．004），输血浆量多[（706．96±422．16）mlvs（551．56±303．37）ml，P=0．000]，术后A纽血浆总使用率低（89．4％VS96．0％，P=0．011）。多元线性回归模型分析，术前是否抗血小板治疗因素（r=-13．770，P=0．618）与术中失血量无显著相关性。手术时间因素（r=1．16，P=0．000）是影响术中失血量的相关因素。结论术前抗血小板治疗不增加择期OPCABG术中失血量，术前双联与单联抗血小板治疗相比不增加手术失血量。

Abstract:

Objective To assess the effects of antiplatelet therapy on perioperative bleeding in patients undergoing off-pump coronary artery bypass grafting （OPCABG）. Methods The related clinical data of 611 patients undergoing OPCABG was retrospectively analyzed. Among 611 patients, 466 received antiplatelet therapy （group Y） and 145 did not （group N） ; in group Y, 94 cases were given aspirin alone （group A）, while 372 cases were given both clopidogrel and aspirin （group AC）.The preoperative, intraoperative and postoperative clinical parameters were compared among groups; intraoperative bleeding volume, postoperative pleural drainage volume and consumption of blood products were documented. Multiple linear regression model was used to analyze the factors influencing intraoperative blood loss. Results The consumption of plasma in group Y during operation was less than that in group N （584.65 ±322.81 ml vs 681.47 ±359.38 ml, P =0.006）. There was no statistical difference in operative time, number of transplant blood vessels, intraoperative blood loss or consumption of red blood cells between group Y and group N. In patients on antiplatelet therapy, the operative time in group A was shorter than that in group ACE （257.02 ±41.84） min vs （273.49 ± 60. 48） min, P = 0. 002 1, and the number of proximal anastomosis was increased in group A, compared to group AC （ 1.76 v 0. 48 vs 1.58 ±0. 60, P = 0. 002 ）. The rate of red blood cell and platelet use was lower in group A than in group AC （90. 4% vs 96. 5%, P =0. 013 ; 4. 3% vs 15.6%, P = 0. 004, respectively）. The consumption of plasma was increased E （ 706.96± 422. 16 ） ml vs （551.56 ±303.37） ml, P =0. 0001 but the rate of postoperative plasma use （89. 4% vs 96.0%, P = 0. 011 ） was decreased in group A, compared to group B. Multiple linear regression model revealed that preoperative antiplatelet therapy was not significantly correlated with intraoperative blood loss （ r = -13.770, P =0.618）, while the operative time was correlated with intraoperative blood loss （r = 1.16, P = 0. 000 ）. Conclusion In patients undergoing OPCABG, the preoperative antiplatelet therapy does not increase the intraoperative blood loss. The dual-drug therapy also does not increase the intraoperative blood loss, compared to the single-drug therapy.