替罗非班的输注策略对冠状动脉内膜剥脱术后出血的影响  

Effect of tirofiban infusion strategy on hemorrhage after coronary endarterectomy

作　　者：何媛[1] 杜莹[1] 张俐鹏 陈敬 许斌[1] He Yuan;Du Ying;Zhang Lipeng;Chen Jing;Xu Bin(Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, 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

出　　处：《中华损伤与修复杂志（电子版）》2022年第2期135-140,共6页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：北京市自然科学基金青年项目(7214222)。

摘　　要：目的探讨替罗非班的输注方式对冠状动脉内膜剥脱术(CE)术后患者出血的影响。方法选入2020年6月至2021年5月在首都医科大学附属北京安贞医院行CE手术患者69例,根据术后患者输注替罗非班方式不同分为应用可调节静脉输液器组(45例)和应用静脉输液泵组(24例),前者采用带有刻度(滚轮或滑轮)输液器,后者采用精密静脉输液泵进行临床治疗:比较2组患者术后替罗非班的输注速度、术后第1天出血量、术后第2天出血量、术后第3天出血量、术后第1天凝血四项检测结果、术后第1天肌钙蛋白检测结果等指标。数据比较采用独立样本t检验或秩和检验、χ^(2)检验,采用线性回归模型分析术后出血量与凝血指标的相关性。结果静脉输液泵组患者术后第1、2天出血量为(472.6±233.6)mL、215.0(152.5,300.0)mL,均显著低于可调节静脉输液器组患者[(1134.8±317.8)mL、480.0(350.0,600.0)mL],差异均有统计学意义(t=8.97,Z=-5.81;P<0.05);可调节静脉输液器组患者术后第1天活化部分凝血活酶时间(APTT)为(33.3±0.4)s,显著高于静脉输液泵组患者[(29.5±3.1)s],差异有统计学意义(Z=-4.66,P<0.05);2组患者术后替罗非班输注速度、术后肌钙蛋白、凝血酶原时间、纤维蛋白原和D二聚体比较差异均无统计学意义(P>0.05);线性回归分析显示术后第1天出血量和术后第2天出血量均与术后第1天APTT存在显著线性关系(R2=0.77、0.49,P<0.05)。结论应用可调节静脉输液器输注替罗非班的CE术后患者APTT显著升高,增加患者术后出血量,而使用静脉输液泵输注替罗非班可显著提高术后安全性。Objective To explore the effect of tirofiban infusion mode on the hemorrhage of patients after coronary endarterectomy(CE).Methods Sixty-nine patients who underwent CE operation in Beijing Anzhen Hospital,Capital Medical University from June 2020 to May 2021 were included.According to the different infusion methods of tirofiban,the patients were divided into two groups:the application of adjustable intravenous infusion device group(45 cases)and the application of amedrop group(24 cases).The former used the infusion device with scale(roller or pulley),and the latter used the precision amedrop for clinical treatment.The postoperative infusion speed of tirofiban,blood loss on the first,second and third day after surgery were recorded and analyzed,the results of four coagulation tests and troponin detection on the first day after surgery,and other indicators were compared between the two groups.The data were compared by independent sample t-test,rank sum test and chi-square test,and linear regression model was used to analyze the correlation between postoperative blood loss and coagulation indicators.Results The blood loss on the first day and the second day after operation in the amedrop group were(472.6±233.6)mL and 215.0(152.5,300.0)mL respectively,which were lower than those in the adjustable intravenous infusion set group[(1134.8±317.8)mL、480.0(350.0,600.0)mL],the differences were statistically significant(t=8.97,Z=-5.81;P<0.05).The activated partial thromboplastin time(APTT)on the first day after operation in the adjustable intravenous infusion set group was(33.3±0.4)s,which was higher than that in the amedrop group[(29.5±3.1)s],the difference was statistically significant(Z=-4.66,P<0.05).There was no significant difference in tirofiban infusion rate,postoperative troponin,prothrombin time,fibrinogen and D dimer between the two groups(P>0.05).Linear regression analysis showed that there was a significant linear correlation between the blood loss on the first day and second day after operation and APTT on

关 键 词：冠心病 冠状动脉内膜剥脱术 替罗非班 术后出血量 药物输注策略 

分 类 号：R28[医药卫生—中药学]