心脏瓣膜置换同期行冠状动脉旁路移植术后老年患者桥血管通畅情况观察  

Patency of the Grafts in Old Patients after Combined Heart Valve and Coronary Artery Bypass Grafting

作　　者：安涛[1] 杨研[3] 乔树宾[1] 杨跃进[1] 毛懿[1] 侯志辉[2] AN Tao;YANG Yan;QIAO Shu-bin;YANG Yue-jin;MAO Yi;HOU Zhi-hui(Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China;Department of Radiology,Fuwai Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China;Department of Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院放射影像科,北京市100037 [3]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,北京市100037

出　　处：《中国分子心脏病学杂志》2020年第1期3205-3208,共4页Molecular Cardiology of China

摘　　要：目的对比抗血小板与抗凝治疗对心脏瓣膜置换同期行冠状动脉旁路移植(coronany artery bypass grafting,CABG)术后老年患者桥血管通畅情况的影响。方法选择2011年1月至2017年12月在我院行心脏瓣膜置换同期CABG手术并规律随诊的患者161例,男118例,平均年龄(67.8±5.25)岁,术后中位随访1608 d。所有患者分为两组,抗血小板治疗组为移植生物瓣或行瓣膜成形术的患者,抗凝治疗组为移植机械瓣的患者。排除标准为:①分期进行心脏瓣膜置换术和CABG术;②术后未规律行抗血小板和(或)抗凝治疗;③合并心房颤动;④行冠脉动脉CT血管造影检查时间为术后6个月以内。结果抗血小板治疗组和抗凝治疗组乳内动脉桥的通畅率分别为78.4%和83.3%(P>0.05),大隐静脉桥通畅率分别为75.9%和71.3%(P>0.05)。随访期间两组出血事件均为牙龈出血,抗血小板组和抗凝治疗组出血事件比率为7.3%和8.9%(P=0.307),两组间比较差异无统计学意义。结论长期抗凝治疗与抗血小板治疗在维持桥血管通畅率方面无显著差异,且在医师指导下接受抗凝治疗的出血风险并未显著高于抗血小板治疗。Objective To observe the effect of antiplatelet therapy or anticoagulant therapy on the patency rate of the grafts in old patients after combined heart valve and coronary artery bypass grafting.Methods 161 patients who received combined heart valve and coronary artery bypass grafting in our hospital from January 2011 to December 2017 were taken as the research objects.The patients were divided into two groups.Patients with the biological valve replacement and valvuloplasty were treated with aspirin alone.The patients with mechanical valve replacement were treated with anticoagulant therapy.Exclusion criteria:①heart valve replacement and CABG were performed in two stages;②Without regular antiplatelet and anticoagulant therapy;③atrial fibrillation;④Computed tomography angiography(CTA)was done within six months after operation.Results The patency rate of left internal mammary artery(LIMA)was 78.4%in antiplatelet the rapy group and 83.3%in antiplatelet group(P>0.05),and the patency rate of saphenous vein graft was 75.9%and 71.3%in the two groups respectively(P>0.05).All the bleeding events were from gums.The rate of bleeding events was 7.3%and 8.9%in the two groups(P=0.307).Conclusion The graft patency rate is not statistically different between the two groups.And there was no statistically difference in bleeding events.

关 键 词：心脏瓣膜病 冠状动脉旁路移植术 同期手术 抗凝治疗 通畅率 

分 类 号：R654.2[医药卫生—外科学]