冠状动脉旁路移植术前对环氧化酶-1抑制性的评估：血小板聚集率与患者自测的对比研究  

作　　者：Niels Rahe-Meyer, MD, PhD Michael Winterhalter, M4 Julia Hartmann Albert Pattison Hartmut Hecker Andreas Calatzis, MD Cristina Solomon, MD 曹晖(译) 

机构地区：[1]Department of Anesthesiology, Hannover Medical School, Hannover, Germany [2]Hart Biologicals, Hartlepool, UK University Hospital Munich, Munich, Germany [3]Institute for Biometry, Hannover Medical School, Hannover, Germany University Hospital Munich, Munich, Germany [4]Department of Hemostasis and Transfusion Medicine, University Hospital Munich, Munich, Germany [5]不详

出　　处：《麻醉与镇痛》2011年第3期32-38,共7页Anesthesia & Analgesia

摘　　要：背景抗血小板治疗导致的血小板功能减退可产生围手术期出血，数项对手术前5日内摄入阿司匹林的影响研究结果不一，有的认为摄入阿司匹林会增加围手术期输血量，而有的认为并无显著影响。本项研究的目的在于对比患者自身报告服药情况与血小板功能测定两种方法评估阿司匹林摄入对围手术期输血需求的影响。方法在一项前瞻性研究中，对100例行冠状动脉旁路移植术的患者，术前5日阿司匹林的摄入进行标准化问卷调查。另外，使用Multiplate血小板功能分析仪测定花生四烯酸介导的全血血小板聚集率。结果23例手术前5日内服用阿司匹林的患者中有11例血小板聚集功能异常，77例手术前未服用阿司匹林的患者中有9例血小板功能异常。服用与未服用阿司匹林的患者相比，手术后24小时内胸管引流量及红细胞输注量无显著差别。手术前血小板聚集功能异常的患者（〈51U）所需的血小板输注量（1．1U）显著高于血小板聚集功能正常的患者（0．3U，P=0．001）。结论本研究结果显示全血花生四烯酸诱导血小板聚集率对于血小板相关的凝血功能异常及血小板输注量的预测优于患者自身报告阿司匹林的摄入情况。BACKGROUND： Hatelet dysfunction due to antiplatelet therapy contributes to perioperative bleeding. Several trials investigating the influence of aspirin intake within the 5 days before surgery reported that transfusion requirements were either increased or not significantly affected by aspirin intake. Our objective was to compare the assessment of aspirin intake by patient self-reporting and by measurement of platelet function with regard to transfusion requirements. METHODS. In a prospective trial, a standardized questionnaire was used in I00 patients for aspirin intake within the 5 days immediately before coronary artery bypass grafting. Whole blood platelet aggregation triggered by arachidonic acid was investigated using the Multiplate; platelet function analyzer. RESULTS： Eleven of 23 patients with aspirin intake within the 5 days before the intervention showed an abnormal aggregation response. Nine of 77 patients who reported no aspirin in- take before surgery had an abnormal aggregation response. There were no significant differences in chest tube drainage and red blood cell transfusion over the first 24 h postoperatively between patients with and without reported aspirin intake. There was no significant difference in chest tube drainage over the first 24 h postoperatively between patients showing normal or abnormal aggregation response. Patients with abnormal aggregation before intervention （ 〈51 U） received significantly more platelet transfusion than patients with normal aggregation （ 1. 1 U compared to 0. 3 U, P = 0. 001 ）. CONCLUSIONS： Our results suggest that arachidonic acid-induced aggregation in whole blood may be a better predictor of plateletrelated coagulopathy and platelet transfusion than the assessment of aspirin intake by patient self-reporting.

关 键 词：冠状动脉旁路移植术 血小板聚集率 手术前 环氧化酶-1 患者 血小板聚集功能异常 评估 血小板功能分析仪 

分 类 号：R654.2[医药卫生—外科学]