抗栓治疗老年患者行结肠息肉内镜切除的安全性研究  

Safety study of antithrombotic therapy for endoscopic colon polypectomy in elderly patients

作　　者：傅亮[1] 吴曦[1] 唐永莲[1] 王薇[1] 罗庆锋[1] 许乐[1] 陈浩[2] Fu Liang;Wu Xi;Tang Yonglian;Wang Wei;Luo Qingfeng;Xu Le;Chen Hao(Department of Gastroenterology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]北京医院消化内科国家老年医学中心,北京100730 [2]北京医院心内科国家老年医学中心,北京100730

出　　处：《中国临床保健杂志》2019年第5期649-652,共4页Chinese Journal of Clinical Healthcare

基　　金：国家自然科学基金(81570307)

摘　　要：目的研究抗栓治疗的老年患者内镜下行结肠息肉切除的安全性。方法筛选住院行结肠息肉切除的2299例抗栓治疗老年患者的病历资料进行回顾性分析,其中高血压病及冠心病患者合计1555例(高血压冠心病组),冠心病支架置入术后患者435例(冠脉支架放置组),人工心脏瓣膜置换术后及心房颤动患者合计309例(人工心脏瓣膜+心房颤动组)。比较各组不良事件发生情况,对比分析围术期不同抗栓药物管理方案与发生出血事件及血栓栓塞的关系。结果冠脉支架放置组出血事件及血栓栓塞发生率高于高血压冠心病组及人工心脏瓣膜+心房颤动组,差异有统计学意义(P<0.05),行结肠息肉切除术前3~5d停用抗凝药物出血事件及血栓栓塞发生率分别为2.00%,2.49%,术后<3d恢复抗凝药物出血事件及血栓栓塞发生率分别为3.34%,1.45%,息肉≥1cm患者内镜切除后出血事件发生率高于息肉<1cm患者,差异有统计学意义(P<0.05),低分子肝素桥接抗凝治疗患者出血事件发生率对比未桥接抗凝患者差异无统计学意义(P>0.05)。结论结肠息肉切除术前3~5d停用抗栓药物,术后<3d恢复抗栓药物可有助于提高抗栓治疗老年患者结肠息肉内镜切除安全性。Objective To study the clinical safety of endoscopic colonic polypectomy in elderly patients with antithrombotic therapy.Methods To retrospectively analyze the medical records of 2 299 patients with anticoagulation for colonic polypectomy,Among them,1 555 patients with hypertension and coronary heart disease(hypertension and coronary heart disease group),435 patients after coronary stent placement(coronary stent group),309 patients with artificial heart valve replacement and atrial fibrillation(artificial Heart valve+atrial fibrillation group).To compare the adverse events of each group,analyze the relationship between different antithrombotic drug management programs during perioperative period and the occurrence of bleeding and thromboembolism.Results The incidence rates of bleeding and thromboembolism in the coronary stent group were higher than those in the hypertensive and coronary heart disease group and the artificial heart valve+atrial fibrillation group.The difference was statistically significant(P<0.05).The incidences of bleeding and thromboembolism when stopping antithrombotics at 3-5 days before colonic polyp resection were 2.00%and 2.49%respectively.The incidences of bleeding and thromboembolism when resuming antithrombotics at<3 days after colonic polyp resection were 3.34%and 1.45%respectively.The incidence of bleeding after endoscopic resection in patients with polyps≥1 cm was higher than that in patients with polyps<1 cm,the difference was statistically significant(P<0.05).There was no significant difference in the incidence of bleeding events between patients with low molecular weight heparin bridged anticoagulation compared with those without unbridged anticoagulation(P>0.05).Conclusion Antithrombotic drugs were discontinued 3-5 days before colon polypectomy and restoration of antithrombotic drugs after<3 days postoperatively can reduce the incidence of bleeding and thromboembolism of endoscopic resection for colon polyps in elderly patients with antithrombotic therapy.

关 键 词：结肠息肉 内窥镜检查 胃肠道 抗凝治疗 出血 血栓栓塞 老年人 

分 类 号：R574.62[医药卫生—消化系统]