非体外循环冠状动脉旁路移植术前停用氯吡格雷及阿司匹林对术后引流量的影响  

Impact of discontinuation of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage

作　　者：赵铁夫[1] 王盛宇[1] 张春晓[1] 张明[1] 王坚刚[1] 曾文[1] 郑帅[1] 陈宏[1] ZHAO Tiefu;WANG Shengyu;ZHANG Chunxiao;ZHANG Ming;WNG Jiangang;ZENG Wen;ZHENG Shuai;CHEN Hong(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing,100029,P.R.China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中国胸心血管外科临床杂志》2021年第4期453-458,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨氯吡格雷和阿司匹林停药时间对行不停跳冠状动脉旁路移植术患者术后引流量及输入血制品的影响。方法纳入2017~2019年北京安贞医院454例冠状动脉粥样硬化性心脏病行非体外循环冠状动脉旁路移植术的患者,根据术前氯吡格雷和阿司匹林的停药状况分为3组:指南组,86例,男59例、女27例,年龄(64.12±6.15)岁,术前持续服用阿司匹林100 mg/d,但停用氯吡格雷≥5 d;不停药组,234例,男141例、女93例,年龄(63.71±7.01)岁,术前持续服用阿司匹林100 mg/d,且停用氯吡格雷<5 d;停药组:134例,男76例、女58例,年龄(62.90±7.78)岁,术前停用阿司匹林,且停用氯吡格雷≥5 d。比较3组临床结果。结果全部患者无围术期死亡。术前血小板计数、凝血功能、肝功能、肾功能和心肌标志物各组差异无统计学意义(P>0.05)。不停药组术后30 min血色素[97(15)g/L vs.98(21)g/L vs.100(20)g/L,F=4.894,P=0.008]低于指南组和停药组;不停药组术后3 h引流量[(399.87±127.19)mL vs.(367.05±125.89)mL vs.(349.63±130.68)mL,F=7.770,P=0.000],术后6 h引流量[600(300)mL vs.580(245)mL vs.550(350)mL,Z=8.218,P=0.016],术后12 h引流量[750(370)mL vs.730(350)mL vs.730(350)mL,Z=8.329,P=0.016],术后24 h引流量[890(365)mL vs.850(340)mL vs.850(350)mL,Z=6.585,P=0.037],术后48 h引流量[950(375)mL vs.940(360)mL vs.940(380)mL,Z=8.680,P=0.013]多于指南组和停药组;不停药组术后引流管保留时间[3(1)d vs.3(1)d vs.3(1)d,Z=6.579,P=0.037]长于指南组和停药组;不停药组术后输入悬浮红细胞量[0(2)U vs.0(2)U vs.0(0)U,Z=6.150,P=0.046],输入血浆量[200(200)mL vs.0(200)mL vs.0(200)mL,F=4.144,P=0.016],输入血浆例数(119例vs.34例vs.47例,Z=10.116,P=0.006)多于指南组和停药组。结论非体外循环冠状动脉旁路移植术术前患者推荐维持阿司匹林治疗,如非必要,至少停服氯吡格雷5 d。Objective To investigate the influence of different discontinuation time of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage and blood products imported.Methods A total of 454 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from January 2017 through December 2019 were included.According to the preoperative discontinuation of clopidogrel and aspirin,all the 454 patients were divided into three groups including a guide group,a non-stop group and a stop group.There were 86 patients in the guide group including 59 males and 27 females with an average age of 64.12±6.15 years.They continued to take aspirin 100 mg/d before operation,but stopped clopidogrel for more than 5 days.In the non-stop group,there were 234 patients including 141 males and 93 females with an average age of 63.71±7.01 years.They continued to take aspirin 100 mg/d before operation,and stopped clopidogrel<5 days.In the stop group,there were 134 patients including 76 males and 58 females with an average age of 62.90±7.78 years.They stopped aspirin and clopidogrel for more than 5 days before operation.The clinical effectiveness was compared among the three groups.Results No perioperative death occurred in all patients.There was no statistical difference in platelet count,coagulation function,liver function,renal function,or myocardial markers among the groups(P>0.05).The hemoglobin[97(15)g/L vs.98(21)g/L vs.100(20)g/L,F=4.894,P=0.008]in the non-stop group was lower than that in the guide group and the non-stop group at 30 minutes postoperatively.The flow volume(399.87±127.19 mL vs.367.05±125.89 mL vs.349.63±130.68 mL,F=7.770,P=0.000)in the non-stop group at 3 hours postoperatively,the flow volume[600(300)mL vs.580(245)mL vs.550(350)mL,Z=8.218,P=0.016]in the non-stop group at 6 hours postoperatively,the flow volume[750(370)mL vs.730(350)mL vs.730(350)mL,Z=8.329,P=0.016]in the non-stop group at 12 hours postoperatively,the flow volume[890(365)mL vs.850(340)

关 键 词：冠状动脉旁路移植术 非体外循环 氯吡格雷 阿司匹林 外科治疗 

分 类 号：R654.2[医药卫生—外科学]