普外围手术期患者应用阿司匹林的实验室监测  

The Laboratory Monitoring of Aspirin Therapy in Perioperative Patients with General Surgery

作　　者：任静[1] 门剑龙[1] 刘伟[1] 张伯玮[1] 马睿[1] 

机构地区：[1]天津医科大学总医院医学检验科,300052

出　　处：《天津医药》2013年第9期871-874,共4页Tianjin Medical Journal

摘　　要：目的研究普外长期服用阿司匹林择期手术患者术前停药的合理时限及术后恢复对血小板功能的影响。方法将121例普外科择期手术患者（试验组）根据术前阿司匹林停用时间分为停药5d组59例和7d组62例。另择50例健康体检者为对照组。采用花生四烯酸（AA）诱导血小板聚集试验测定各组血小板聚集率（PAgT），ELISA法测定尿11-脱氢-血栓烷B2（11-DH-TXB2）。于术后24～48h内恢复使用阿司匹林，测定恢复用药7d和10d时5minPAgT和11-DH—TXB2。结果停药5d组停药后5min、8min和10minPAsT均低于对照组和停药7d组（均P〈0．05）；停药7d组与对照组差异无统计学意义。停药5d时，血小板聚集出现延迟聚集和低程度聚集曲线2种特征，停药7d时呈正常聚集曲线。试验组术后恢复用药7d和10d时5minPAgT、11-DH—TXB2均低于对照组，恢复用药7d时水平高于10d时（均P〈0．05）。结论术前停用阿司匹林7d时患者血小板功能基本恢复正常状态；术后恢复应用阿司匹林对患者实验室监测的时间应延长至7d后。Objective To investigate the reasonable time limit for stopping the aspirin treatment in preoperative pa- tients with general surgery and the effects on platelet function in postoperative patients with recovering the therapy of aspirin. Methods A total of 121 patients undergoing elective general surgery were divided into stopping aspirin treatment 5 d group （n=59） and stopping aspirin treatment 7 d group （n=62）. Fifty healthy volunteers were used as the control group. The arachidonic acid （AA）-induced platelet aggregation test was used to detect the platelet agglutination rate in all groups. Aspirin was reused 24 - 48 h after surgery. The level of urinary 11-dehydro- thromboxane B2 （11-DH-TXB2） was assayed by ELISA 7 and 10 d after retreatment. Results The levels of the PAgT （5 min, 8 min and 10 min） were decreased significantly in patients with stopping aspirin treatment 5 d group compared with those of patients with stopping aspirin treatment 7 d group and control group （P 〈 0.05）. There was no significant difference in the level of PAgT between patients with stopping aspirin treatment 7 d group and control group. The platelet aggregation showed two different characteristic curves after stopping aspirin treatment for 5 d. And the normal curve of platelet aggregation was found after stopping aspirin treatment for 7 d. The levels of PAgT and urinary 11-DH-TXB2 were significantly lower in patient recovered the aspirin treatment for 7 d and 10 d than that of control, and which was significantly higher in 7 d group than that of 10 d group （P 〉 0,05）. Conclusion The platelet aggregative function returned to normal level in patients with 7-d preoperative stopping aspirin. The laboratory monitoring of aspirin therapy should be more than 7 d after postoperative reusing aspirin.

关 键 词：花生四烯酸 血小板聚集 阿司匹林 手术期间 PAGT 尿11-脱氢-TXB2 

分 类 号：R473.6[医药卫生—护理学]