左主干病变择期冠脉搭桥术前应用氯吡格雷的效果和风险  

Effect and risk of applying clopidogrel before elective coronary artery bypass grafting in left main disease

作　　者：李波[1,2] 顾承雄[1,2] 杨俊峰[1,2] 韦华[1,2] 李京悻[1,2] 刘锐[1,2] 黄信生[1,2] 李晖[1,2] 李琴[1,2] 李海涛[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所心脏外科,北京市100029

出　　处：《河北医药》2014年第10期1445-1448,共4页Hebei Medical Journal

基　　金：国家自然科学基金资助项目(编号:81370436)

摘　　要：目的评价左冠脉主干狭窄患者择期非体外循环冠脉搭桥手术术前在应用低分子肝素的基础上合用氯吡格雷的安全性及有效性。方法对228例左冠脉主干病变施行择期非体外循环冠脉搭桥的患者进行回顾性分析。根据术前5 d内是否停用氯吡格雷,将患者分为双联抗栓组及单纯应用低分子肝素组。比较2组患者术前不良心血管事件的发生(死亡、不稳定心绞痛、急性心肌梗死)、主动脉球囊反搏使用,及术后出血的发生情况。结果双联抗栓组术前不良心血管事件发生率显著低于低分子肝素组,前者术后出血量和输血量略多于后者,但2组之间主动脉球囊反搏使用、术后消化道出血、脑出血、开胸止血发生率、正性肌力药的使用、监护时间差异无统计学意义(P>0.05)。结论对于左冠脉主干狭窄拟行择期CABG术患者,在应用低分子肝素抗凝的基础上,术前5 d内继续应用氯吡格雷与降低术前心血管事件呈相关性,且不增加严重出血风险。Objective To evaluate the safety and effect of applying LMWH （ low molecular weight heparin ） with clopidogrel before elective off-pump coronary artery bypass grafting in left main disease .Methods Retrospective analysis of the 228 patients of left main coronary stenosis cases undertaking elective off-pump coronary bypass grafting .All patients were divided into clopidogrel group （ combined with LMWH ） and pure LMWH group （ applying LMWH only ） .Compare the adverse cardiovascular events （ death,unstable angina pectoris ,acute myocardial infarction ） ,and the post operation hemorrhage in both groups.Results In clopidogrel group,the occurrence rate of adverse cardiovascular events was remarkably lower ,while the postoperative bleeding amount and transfusion amount were a little more than those in LMWH group .There were no obvious differences on intra-aortic balloon pump using ,gastrointestinal bleeding ,cerebral hemorrhage ,thoracotomy hemostasis rate ,the using of positive inotropic drug and the staying time in ICU .Conclusion Compared with merely applying LMWH ,combined applying clopidogrel with LMWH 5 days before elective off-pump coronary bypass grafting can relatively reduce preoperative adverse cardiovascular events in patients of left main coronary stenosis and do not increase the serious bleeding complication .

关 键 词：冠脉搭桥术 氯吡格雷 左冠脉主干狭窄 

分 类 号：R543.3[医药卫生—心血管疾病]