冠状动脉内膜剥脱术联合冠状动脉旁路移植术后不同抗血栓策略的早期疗效比较  

Comparison of different antithrombotic strategies after coronary endarterectomy combined with coronary artery bypass grafting

作　　者：吴震[1] 刘长城[1] 方颖[1] 王素珍[2] 顾承雄[1] Wu Zhen;Liu Changcheng;Fang Ying;Wang Suzhen;Gu Chengxiong(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;School of Public Health and Management,Weifang Medical College,Shandong Province,Weifang 261053,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029 [2]潍坊医学院公共卫生与管理学院,261053

出　　处：《中国医药》2020年第6期843-846,共4页China Medicine

基　　金：国家自然科学基金(81370436、81872719)。

摘　　要：目的比较冠状动脉内膜剥脱术(CE)联合冠状动脉旁路移植术(CABG)后不同抗血栓策略的早期效果。方法选取2014年1月至2018年1月在首都医科大学附属北京安贞医院心脏外科接受择期非体外循环心脏不停跳CE+CABG的患者416例。完全随机分为常规治疗组(208例,术后接受阿司匹林和氯吡格雷治疗)和综合治疗组(208例,常规治疗+低分子肝素联合前列腺素E1)。比较2组患者术后引流量、输血比例、出血事件、围术期心肌梗死发生率和术后30 d全因死亡率。结果综合治疗组患者术后引流量显著多于常规治疗组[(1540±422)ml比(1350±368)ml],差异有统计学意义(P<0.001);但2组患者输血比例和出血事件发生率差异均无统计学意义(均P>0.05)。综合治疗组患者术后30 d心肌梗死和全因死亡的终点事件总发生率显著低于常规治疗组[5.8%(12/208)比11.5%(24/208)],差异有统计学意义(P<0.05)。结论双联抗血小板+低分子肝素和前列腺素E1联合抗血栓策略可显著降低CE+CABG患者的围术期心肌梗死和术后30 d死亡的风险,且不增加出血风险。Objective To compare different antithrombotic therapy in patients with coronary endarterectomy(CE)combined with coronary artery bypass grafting(CABG).Methods From January 2014 to January 2018,416 patients who underwent scheduled CE+CABG in Beijing Anzhen Hospital,Capital Medical University were randomly divided into two groups:the conventional treatment group(208 cases,treated by aspirin and clopidogrel after surgery);the comprehensive treatment group(208 cases,conventional treatment+low molecular weight heparin combined with alprostadil).The postoperative drainage volume,transfusion ratio,bleeding events,perioperative myocardial infarction rate and 30-day postoperative mortality were compared between the two groups.Results The postoperative drainage volume was significantly higher in the comprehensive treatment group than that in the conventional treatment group[(1540±422)ml vs(1350±368)ml](P<0.001),but there were no significant difference in the transfusion ratio and bleeding events between the two groups(all P>0.05).The incidence of myocardial infarction and 30-day postoperative mortality after surgery was significantly lower in comprehensive treatment group than that in conventional treatment group[5.8%(12/208)vs 11.5%(24/208)](P<0.05).Conclusion Dual antiplatelet+low molecular weight heparin and alprostadil,as antithrombotic strategy,significantly reduce the incidence of myocardial infarction and 30-day postoperative mortality in patients with CE+CABG without increasing risk of bleeding.

关 键 词：冠状动脉旁路移植术 冠状动脉内膜剥脱 抗血栓治疗 围术期心肌梗死 

分 类 号：R816.2[医药卫生—放射医学]