术前口服抗血小板药物的急性A型主动脉夹层动脉瘤的临床手术效果分析  

Outcomes of preoperative antiplatelet therapy in patients with acute type A aortic dissection

作　　者：张帅 刘杨[1] 蒋璇[2] 谷天祥[2] ZHANG Shuai;LIU Yang;JIANG Xuan;GU Tian-xiang(Department of Pediatric Surgery,Shengjing Hospital,China Medical University,Shenyang 110001,China;Department of Cardiac Surgery,First Affiliated Hospital,China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属盛京医院小儿外科,辽宁省沈阳市110001 [2]中国医科大学附属第一医院心脏外科

出　　处：《中国心血管病研究》2021年第10期916-922,共7页Chinese Journal of Cardiovascular Research

基　　金：国家自然基金青年基金(82000437);国家重点研发计划(2017YFC1308000)。

摘　　要：目的分析急性A型主动脉夹层患者术前抗血小板治疗对其临床结局的影响。方法回顾性分析中国医科大学附属第一医院及盛京医院2015年至2020年收治的523例主动脉夹层患者,其中有31名在术前接受过阿司匹林或氯吡格雷或两者联合使用的抗血小板治疗。在倾向评分匹配后,口服抗血小板治疗(antiplatelet therapy,DAT)组中患者为30例,非DAT组为80例。结果 DAT组中有10例(33%)患者既往接受经皮冠状动脉介入治疗(冠状动脉支架置入术)。DAT组的红细胞输入量较非DAT组更多[1400(800,1926)ml比0(0,1176)ml,P<0.001];血浆输入量[0(0,800)ml比0(0,300)ml,P=0.004]以及血小板输注量[(14.07±8.92)IU比(9.90±8.47)IU,P=0.026]均更多。DAT组的心包及胸骨后引流量更多[(5009.37±2131.44)ml比(3608.38±2294.40)ml,P=0.004]。DAT组的病死率相对非DAT组更高(26%比10%,P=0.027)。术前DAT是病死率的独立预测因子(OR=6.808,95%CI 1.554~29.828,P=0.011)。结论急性A型主动脉夹层动脉瘤(acute type A aortic dissection,ATAAD)手术前口服DAT与可能导致更多的输血和更高的早期病死率。临床医师应根据患者的状况和外科医师的经验仔细考虑手术时机。Objective To explore the effect of preoperative antiplatelet therapy(DAT) on the clinical outcome of patients with acute type A aortic dissection(ATAAD). Methods A retrospective analysis of 523 patients with ATAAD admitted to Shengjing Hospital and The First Affiliated Hospital, China Medical University from 2015 to 2020 was conducted, 31 of whom had received antiplatelet therapy with aspirin or clopidogrel or a combination of both before surgery. The remaining samples after the matching analysis were 30 cases in the DAT group and 80 cases in the non-DAT group. Results There were 10 patients(33%) in the DAT group had previously received percutaneous coronary intervention. The transfusion of red blood cell in the DAT group was greater [1400(800,1926) ml 比 0(0,1176) ml,P<0.001];the plasma input was much more [0(0,800) ml 比 0(0,300) ml,P=0.004] and so was the platelet transfusion [(14.07 ± 8.92) IU vs.(9.90 ± 8.47) IU, P=0.026]. The pericardium and chest drainage in the DAT group were more [(5009.37±2131.44) ml vs.(3608.38±2294.40) ml, P=0.004]. The mortality rate of the DAT group was higher than that of the non-DAT group(26% vs. 10%, P=0.027).Preoperative DAT was an independent predictor of mortality(OR=6.808,95%CI 1.554~29.828, P=0.011).Conclusion Preoperative DAT on ATAAD is associated with more blood transfusions and higher mortality. The physicians should carefully consider the timing of surgery based on the patient’s condition and the surgeon’s experience.

关 键 词：急性主动脉夹层 抗血小板治疗 抗凝 深低温停循环 

分 类 号：R543.1[医药卫生—心血管疾病]