不同抗凝和抗血小板治疗策略对心律植入装置术后囊袋血肿的影响  

Effect of different antiplatelet or anticoagulation therapy on postoperative pocket hematoma after electrophysiological devices placement

作　　者：陈妍 张慧智 郭成军[3] 曾哲淳[3] 李海宴[3] 方东平[3] 戴文龙[3] 张金荣[3] 刘寅 赵茹 孟康[3] 

机构地区：[1]天津胸科医院心内科,300081 [2] 天津海滨人民医院重症医学科 [3] 首都医科大学附属北京安贞医院心内科

出　　处：《中华老年医学杂志》2015年第6期589-592,共4页Chinese Journal of Geriatrics

基　　金：北京市科技计划项目（Z11110705）

摘　　要：目的 探讨围术期不同的抗凝、抗血小板治疗策略对于心律植入装置（EPD）术后囊袋血肿的影响. 方法 2010年1月至2013年1月北京安贞医院收治的正在服用抗血小板、抗凝药物并且需要植入永久起搏器、心脏再同步化治疗、埋藏式心律转复除颤器的老年患者,根据不同的治疗策略,分成4组：双重抗血小板治疗组（DAP组）、低分子肝素桥接（LMWH）组、单用阿司匹林组（ASA）和华法林组,观察患者EPD植入后囊袋血肿的发生率. 结果 入选患者324例,DAP组、ASA组、LMWH组、华法林组的囊袋血肿发生率为4.93％（4/81）、3.70％（3/81）、18.25％（15/81）和2.47％（2/81）.LMWH桥接组与其他3组比较差异有统计学意义（均P＜0.05）;DAP组、ASA组、华法林组组间比较差异无统计学意义（均P＞0.05）.Logistic回归分析显示,LMWH桥接治疗是患者发生囊袋血肿的独立危险因素,患者发生囊袋血肿的风险是接受其他治疗患者的7倍（OR=7.124,95％ CI：1.861～27.271）. 结论 LMWH桥接治疗增加EPD置入后囊袋血肿的风险.Objective To investigate the effect of different antiplatelet or anticoagulation therapy on postoperative pocket hematoma after electrophysiological devices placements （EPD）.Methods The selected patients were taking anti-platelet or anticoagulation therapy and needed implanted permanent pacemaker,cardiac resynchronization therapy and implantable cardioversion defibrillator in our Beijing Anzhen hospital from January 2010 to January 2013.According to the type of therapy,patients were divided into 4 groups：dual anti-platelet therapy （DAP,aspirin and clopidogrel） group,low-molecular-weight heparin （LMWH,enoxaparin） bridging group,aspirin alone （ASA） group and warfarin group.The incidences of pocket hematoma after electrophysiological devices placements were observed in groups.Results A total of 324 patients were enrolled in the study.The incidence of pocket hematoma was higher in LMWH bridging group than in the other 3 groups [18.25% （15/81） vs 4.93% （4/81）,3.70% （3/81）,2.47% （2/81）,all P〈0.05],but there were no significant differences in the incidence of pocket hematoma among DAP,ASA and warfarin group S （all P〉 0.05）.The multiple logistic regression analysis revealed that LMWH bridging therapy was an independent risk factor for the development of pocket hematoma：patients with LMWH bridging therapy were 7 fold more likely to develop pocket hematomas than the individuals with other treatment （OR =7.124,95% CI：1.861-27.271）.Conclusions LMWH bridging therapy increases the risk of development of pocket hematomas after electrophysiological devices placement.

关 键 词：阿司匹林 华法林 肝素 心脏辅助装置 血肿 

分 类 号：R54[医药卫生—心血管疾病]