冠状动脉分期杂交治疗的抗凝和抗血小板临床经验总结  

Clinical experience of anticoagulation and antiplatelet therapy for staged hybrid coronary revascularization

作　　者：王有余 杨小东[1] 王晓民 许哲通[1] 张鲁锋[2] 万峰[2] WANG You-yu;YANG Xiao-dong;WANG Xiao-min(Department of Cardiology, Booding Second Central Hospital, Zhuozhou 072750, Chin)

机构地区：[1]保定市第二中心医院心血管内科,河北省涿州市072750 [2]北京大学第三医院心脏外科

出　　处：《中国心血管病研究》2018年第5期453-455,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的 探索冠状动脉分期杂交技术围手术期抗凝和抗血小板治疗方案的安全性和有效性.方法 选取2015年12月至2016年8月,20例经冠状动脉造影确诊为多支冠状动脉病变的冠心病患者接受分期杂交冠状动脉治疗.按照制订的治疗计划,患者首先接受微创不停跳左乳内动脉至前降支搭桥,5d后接受冠状动脉介入治疗非前降支血管.手术前服用阿司匹林100 mg/d连续5d以上;手术中使用肝素1～3mg/kg,维持活化凝血时间＞300 s,术毕鱼精蛋白中和肝素比例为1∶2.手术后第一日起口服阿司匹林100mg/d＋氯吡格雷75mg/d直至第5日接受冠脉介入治疗,完成冠脉介入治疗之后终身服用阿司匹林100 mg/d及1年硫酸氯吡格雷75mg/d.评价住院期间及随访1年的主要心脑血管不良事件,统计出血并发症,总结临床治疗效果,评价本研究方案的安全性和有效性.结果 20例患者均按计划顺利接受冠状动脉分期杂交治疗.住院期间及随访1年内主要心脑血管不良事件发生率为0.患者出血风险未增加.结论 冠状动脉分期杂交治疗所采用的围手术期抗凝及抗血小板治疗方案安全、有效.Objective To investigate the safety and effectiveness of perioperative anticoagulation and antiplatelet therapy for staged hybrid coronary revascularization in patients with multivessel coronary artery stenosis.Methods From Dec 2015 to Aug 2016,20 patients with multi-vessel coronary artery disease underwent staged hybrid coronary revascularization,which combined of minimally invasive direct coronary artery bypass and percutaneous coronary intervention.Oral aspirin of 100 mg/day was given before surgery.Intro-operative administration of heparin （1-3 mg/kg） to maintain active coagulation time over 300 second was neutralized by procaine at a ratio of 1∶2.Postoperative oral Aspirin（100 mg/day） and Clopidogrel（75 mg/day） lasted for 5 days until percutaneous intervention of other coronary artery lesions.Thereafter Aspirin （100 mg/day） for lifetime and Clopidogrel （75 mg/day） for 1 year was given for antiplatelet therapy.Major adverse cardiac and cerebral vascular events in hospital and at 1 year follow up were collected.Results 20 patients underwent successful staged hybrid coronary revascularization.No major adverse cardiac and cerebral vascular events occur during hospitalization and follow up.No bleeding events occurred in all patients.Conclusion This perioperative anticoagulation and antiplatelet therapy for staged coronary revascularization is safe and effective.

关 键 词：经皮冠状动脉介入 杂交技术 抗血小板治疗 抗凝治疗 

分 类 号：R654.2[医药卫生—外科学]