冠状动脉搭桥术后患者对抗血小板药物低反应性的危险因素分析  

Risk factor analysis for a low response to anti-platelet drugs after coronary artery bypass grafting

作　　者：吴丹娜[1,2] 余成[3] 谢静[2] 覃业语[2] 韩方璇[2] 徐萍[1] WU Danna;YU Cheng;XIE Jing;QIN Yeyu;HAN Fangxuan;XU Ping(Department of Pharmacy,The Second Xiangya Hospital of Central South University,Changsha,Hunan 410011,China;Department of Pharmacy;Department of Cardiac Surgery,Hainan General Hospital,Haikou,Hainan 5703 l 1,China)

机构地区：[1]中南大学湘雅二医院药学部,湖南省长沙市410011 [2]海南省人民医院药学部 [3]海南省人民医院心脏外科,海南省海口市570311

出　　处：《中国动脉硬化杂志》2018年第8期798-802,共5页Chinese Journal of Arteriosclerosis

基　　金：海南省卫生计生行业科研项目(15A200087);海南省科协青年科技英才学术创新计划项目(QCXM201814)

摘　　要：目的探究行冠状动脉搭桥手术后发生高血小板反应性的影响因素。方法选择2015年5月至2016年5月行冠状动脉搭桥术并符合纳入标准的患者90例,术后服用阿司匹林肠溶片和氯吡格雷片双联抗血小板治疗且行血栓弹力图检测,查阅病案系统建档并电话随访1年,记录患者随访期间发生的缺血事件和出血事件,分为高血小板反应性组和正常血小板反应性组,评估血栓弹力图检测的高血小板反应性与冠状动脉搭桥患者对应因素的相关性。结果年龄、尿酸、谷丙转氨酶、谷草转氨酶、术中输血量、24 h引流量、手术时长、术后血栓弹力图指标（血块动力K、血块强度MA（thrombin）、凝血综合指数CI、血块强度MA（ADP））有统计学差异（P〈0.05）。多因素二元Logistic回归分析显示尿酸升高与发生高血小板反应性呈正相关（OR=1.011,95%CI为1.003-1.019,P〈0.05）。结论尿酸升高可能是导致冠状动脉搭桥患者对抗血小板药物反应低下的危险因素。Aim To explore the influence factors of high on-treatment platelet reactivity after coronary artery by- pass grafting. Methods From May 2015 to May 2016, ninety patients accordance with the inclusion criteria were en- rolled in this study, and were treated with aspirin enteric-coated tablets and clopidogrel tablets double antiplatelet in combi- nation with thrombelastogram （TEG） detection. Archives were established by consulting the case system and followed-up for 1 year. The status of ischemic events and bleeding events had been recorded by telephone during the follow-up period. The patients were divided into high on-treatment platelet reactivity （HTPR） group and normal on-treatment platelet reactiv- ity （NTPR） group. The collected data were analyzed to evaluate the correlation between TEG detected high on-treatment platelet reactivity and some factors in patients with coronary artery bypass grafting. Results Age, uric acid, alanine aminotransferase, aspartate aminotransferase, intraoperative blood transfusion, 24 h drainage, duration of operation, post- operative TEG （ blood clotting K, blood clot strength MAthrombin, coagulation syndrome CI, blood clot strength MAADP ） were statistically different （P〈0.05）. Multivariate Logistic regression analysis showed that uric acid elevation was positively correlated with occurrence of HTPR （OR=1.011, 95%CI was 1.003- 1.019, P〈0.05）. Conclusion Serum uric acid level may be a causal risk factor for a low response to anti-platelet drugs.

关 键 词：高血小板反应性 冠状动脉搭桥 血栓弹力图 尿酸 

分 类 号：R969[医药卫生—药理学]