体外循环下冠状动脉旁路移植术后获得性阿司匹林抵抗现象的研究  

Analysis of aspirin resistance followed conventional on-pump coronary artery bypass graft

作　　者：王妍军[1] 吴明营[1] 吴文波[1] 周自强[1] 崔华楠[1] Wang Yanjun;Wu Mingying;Wu Wenbo;Zhou Ziqiang;Cui Huanan(Department of Cardiovascular Surgery,Beifing Tongren Hospital,Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院心血管中心心外科,100176

出　　处：《北京医学》2018年第9期811-813,共3页Beijing Medical Journal

摘　　要：目的研究体外循环冠状动脉旁路移植(conventional on-pump coronary artery bypass graft, CCABG)术后早期(14 d内)获得性阿司匹林抵抗(aspirin resistance, AR)的发生情况。方法 54例接受CCABG手术患者,术前常规停用阿司匹林5～7 d,术后6 h起按常规剂量(100 mg/d)口服阿司匹林,分别于术前最后1次服用阿司匹林后6 h(T_0)、术后第1次服用阿司匹林后6 h(T_1)、第5天(T_2)、第10天(T_3)以及第15天(T_4)应用血栓弹力图(thromboelastog-raphy, TEG)检测花生四烯酸诱导的血小板聚集抑制率(AA-induced inhibition rate, INHAA),同时记录患者各项临床资料。结果术后INHAA在T_2、T_3时显著低于术前T_0(P <0.05),且T_2显著低于T_3,T_1、T_4时与T_0时差异不明显,术后发生AR的例数分别为T_14例(7.4%),T_225例(46.3%),T_38例(14.8%),T_42例(3.7%)。结论 CCABG术后早期,阿司匹林抗血小板聚集的作用受到抑制,部分患者出现一过性AR,应予以更为积极的抗血小板治疗。Objective To explore the efficacy of aspirin and incidence of postoperative aspirin resistance （AR） in patients early after conventional on-pump coronary artery bypass graft（CCABG）. Methods Fifty-four patients undergoing CCABG surgery were enrolled in the study. Aspirin treatment （100 mg/d） was paused 5～7 days before CCABG and continued 6 hours after surgery. Clinical data and blood samples were collected in the following time points： 6 hours after taking the last dose of aspirin before surgery （T0）, 6 hours after taking the first dose of aspirin after surgery（T1）, the 5 th day（T2）, 10 th day（T3） and 15 th day（T4） after surgery. Arachidonic-acid-induced inhibition rate（INHAA） at each time points were calculated by thrombelastography（TEG）. Results The overall levels of INHAAat T2 and T3 were significantly lower than that at T0（P〈0.05）, meanwhile the INHAAat T2 was significantly lower than that at T3（P〈0.05）. There was no significant difference compared T0 with T1 and T4. There were 4 patients（7.4%）, 25 patients（46.3%）, 8 patients（14.8%）and 2 patients（3.7%） with AR at T1～T4 respectively. Conclusion Aspirin does not sufficiently inhibit platelet aggregation at the early stage after CCABG. AR appears on part of patients following CCABG. It is necessary to keep more potential anti-coagulation therapy in the early postoperative period.

关 键 词：体外循环冠状动脉旁路移植术 阿司匹林抵抗 血小板聚集 抗药性 

分 类 号：R654.2[医药卫生—外科学]