抗栓药物治疗对神经重症患者行经皮扩张气管造口术后出血的影响因素分析  

Effect of antithrombotic drug therapy on bleeding after percutaneous dilational tracheostomy in neurocritical care patients

作　　者：王涛 曾静[1] 叶秋明[1] 杨楠[1] Wang Tao;Zeng Jing;Ye Qiuming;Yang Nan(Department of Neurology,Zhongshan Hospital of Traditional Chinese Medicine,Zhongshan,Guangdong 528400,China)

机构地区：[1]广东省中山市中医院神经内科,528400

出　　处：《中国脑血管病杂志》2021年第11期772-777,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：中山市卫生健康局医学科研项目(2021J169)。

摘　　要：目的探讨抗栓药物治疗对神经重症患者行经皮扩张气管造口术(PDT)后出血的影响因素。方法回顾性连续纳入2017年8月至2020年12月在中山市中医院神经内科重症监护病房以及综合重症监护病房接受经PDT的神经危重症患者56例,其中脑梗死42例。根据PDT术后是否发生出血并发症,将所有患者分为出血组(22例)和无出血组(34例)。无明显出血为未行任何止血处理,少量出血为穿刺部位需敷料加压止血,严重出血为需外科手术干预止血,并将少量出血和严重出血计为出血,无明显出血计为无出血。记录两组患者的人口学特征和临床资料,包括年龄、性别、气管切开原发疾病、抗栓药物使用情况、气管切开前凝血功能检查(血小板计数、凝血酶原时间、国际标准化比值、活化部分凝血活酶时间、纤维蛋白原)、住院期间死亡事件,并进行对比分析。以PDT后发生穿刺部位出血为因变量,将单因素分析中P<0.1的参数进一步行术后出血影响因素的多因素Logistic回归分析。由于抗栓药物使用与PDT后出血的关系为本研究的目的,故将其作为自变量纳入多因素Logistic回归分析。结果(1)56例行PDT的神经危重症患者中,33例(58.9%)脑梗死患者在行PDT前接受规律的抗栓药物治疗,包括单联抗血小板聚集药物治疗11例(19.6%),双联抗血小板聚集药物治疗15例(26.8%),抗凝药物治疗7例(12.5%),无抗凝联合抗血小板聚集治疗者,其中单联抗血小板聚集治疗分别为6例患者口服阿司匹林、5例患者口服氯吡咯雷;23例未使用抗栓药物(41.1%),包括9例脑梗死患者因颅内出血转化未使用抗栓药物治疗。(2)56例行PDT的神经危重症患者中,术后穿刺部位无明显出血34例(60.7%),少量出血22例(39.3%),无严重出血事件发生;住院期间死亡患者2例(3.6%),分别为一氧化碳中毒迟发性脑病和吉兰-巴雷综合征,分别因突发心肌梗死、呼吸循环衰竭Objective To investigate the effect of antithrombotic drug therapy on the risk of bleeding after percutaneous dilational tracheostomy(PDT)in neurocritical care patients.Methods A total of 56 neurocritical care patients who received PDT in the neurology intensive care unit and comprehensive intensive care unit of Zhongshan Hospital of Traditional Chinese Medicine from August 2017 to December 2020 were enrolled retrospectively,including 42 cases of cerebral infarction.According to whether there were bleeding complications after PDT,all patients were divided into bleeding group(22 cases)and non-bleeding group(34 cases).Bleeding was classified as absent or minimal(stopping without any intervention),moderate(needs wound dressing pressure on puncture site to stop bleeding)and serious(requiring surgical intervention);moderate bleeding and serious bleeding were counted as bleeding group,and absent or minimal bleeding was counted as non-bleeding group.The demographic characteristics and clinical data of the two groups were recorded and compared,including age,gender,primary disease of tracheotomy,use of antithrombotic drugs,coagulation test before tracheotomy(platelet count,prothrombin time,international standardized ratio,activated partial thromboplastin time,fibrinogen)and death events during hospitalization.Taking the bleeding at the puncture site after PDT as the dependent variable,the parameters of P<0.1 in univariate analysis were further analyzed by multivariate Logistic regression analysis.As the relationship between the use of antithrombotic drugs and bleeding after PDT was the purpose of this study,the use of antithrombotic drugs was included in multivariate Logistic regression analysis as an independent variable.Results(1)Among the 56 neurocritical care patients with PDT,33 patients(58.9%)with cerebral infarction received regular antithrombotic drugs before PDT,including 11 patients(19.6%)with mono antiplatelet therapy(6 patients took Aspirin orally and 5 patients took clopidogrel orally),15 patients(26.8%)recei

关 键 词：气管切开术 神经重症 缺血性卒中 抗栓药物 出血 

分 类 号：R741[医药卫生—神经病学与精神病学]