非体外冠状动脉旁路移植术后早期强化抗栓治疗对出血的影响  

Impact of Early Dual Antiplatelet Therapy on Postoperative Bleeding After Off-pump Coronary Artery Bypass Grafting

作　　者：高歌[1] 郑哲[1] 胡盛寿[1] 王巍[1] 宋云虎[1] 王欣[1] 

机构地区：[1]北京协和医学院/中国医学科学院心血管病研究所/阜外心血管病医院心外科,100037

出　　处：《医学研究杂志》2010年第6期20-23,共4页Journal of Medical Research

基　　金：国家科技支撑项目(2006BAI01A09);北京市科委关于2006年度科技促进市民生活质量改善主题项目(D0906004040391);中央级公益型科研院所基本科研业务费(2009-2011)

摘　　要：目的评价术后联合应用阿司匹林加氯吡格雷抗血小板治疗对非体外循环下冠状动脉旁路移植术(off-pumpCABG,OPCAB)后出血的影响。方法2007年12月～2008年12月期间在我院成功接受OPCAB的患者130名,术后随机分配到阿司匹林组(A组)和阿司匹林加氯吡格雷组(AC组)。两组采用不同的抗血小板治疗方案:A组59例,口服阿司匹林100mg/d;AC组71例,口服阿司匹林100mg+氯吡格雷75mg/d。记录并比较两组患者术前基线资料、实验室检查结果、术中术后情况,以及两组患者术后胸腔引流量、血及血制品使用量。结果两组患者术前、术中的基线资料及实验室检查结果比较差异无统计学意义(P>0.05);A组和AC组胸腔引流总量比较差异无统计学意义(1000.76±382.88mlvs1057.96±475.32ml,P=0.458)。A组和AC组给予抗血小板药物后的胸腔引流量比较差异无统计学意义(463.13±261.48mlvs469.12±249.45ml,P=0.914)。两组患者中均未发生围术期死亡、二次开胸止血或严重的胸外出血情况。结论OPCAB术后早期采用双联抗血小板治疗不会导致术后出血的显著增加。ObjectiveTo evaluate the impact of early dual antiplatelet therapy on postoperative bleeding early after off-pump coronary artery bypass grafting. Methods130 patients were randomized into two groups after successful OPCAB from December of 2007 to December of 2008. Daily clopidogrel （75mg） and aspirin （100mg） were initiated in 71 patients （Group AC） or aspirin（100mg） alone in 59 patients （Group A）. Demographic, operative, and post- operative data were compared between groups,including chest tube drainage and dosage of blood product. ResultsNo substantial differences in baseline characteristics and laboratory examination were observed between the two groups. Total chest tube drainage（1000.76±382.88ml vs 1057.96±475.32ml, P=0.458） and drainage after patients received antiplatelet agents（463.13±261.48ml vs 469.12±249.45ml,P=0.914）were not significantly different between group A and group AC. No perioperative mortality, reexploration or extrathoracic bleeding occurred in either group. ConclusionThe present study suggests that dual antiplatelet therapy of aspirin and clopidogrel can safely be administered in the early post-operative period in OPCAB patients, without increasing the risk of bleeding complications.

关 键 词：非体外循环下冠状动脉旁路移植术 氯吡格雷 抗血小板治疗 出血 胸腔引流量 

分 类 号：R654.2[医药卫生—外科学]