腹膜透析置管术围手术期应用抗凝或抗血小板药物对出血及心脑血管事件的影响  

Effect of anticoagulant or antiplatelet drugs on bleeding and cardio-cerebral vascular events in perioperative period of catherization for peritoneal dialysis

作　　者：苏凯杰 王晓晓[1] 唐雯[1] Su Kaijie;Wang Xiaoxiao;Tang Wen(Kidney Department,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院肾内科,北京100191

出　　处：《中华肾脏病杂志》2022年第4期320-328,共9页Chinese Journal of Nephrology

基　　金：北大百度基金资助项目(2020BD030);中华国际医学交流基金会肾性贫血科研基金(Z-2017-24-2037)。

摘　　要：目的分析腹膜透析(腹透)置管术围手术期使用抗凝或抗血小板药物对患者发生出血和心脑血管事件的影响。方法回顾性收集和分析2010年7月1日至2020年12月31日在北京大学第三医院接受腹透置管术患者手术前后的临床资料。根据患者术前是否停用抗凝或抗血小板药物分为停药组和未停药组,比较两组患者基线临床资料、术后出血和心脑血管事件的差异。采用多因素Logistic回归分析法分析腹透置管术围手术期发生出血和心脑血管事件的影响因素。结果共57例患者被纳入本研究,男性34例,女性23例,年龄(67.37±13.93)岁(范围27~97岁)。停药组37例,未停药组20例。未停药组患者术前3个月内(10/20比3/37,χ^(2)=10.671,P=0.001)及术前6个月内(11/20比3/37,χ^(2)=12.980,P<0.001)发生急性心肌梗死事件的比例显著高于停药组。停药组术前中位停药时间为5.0(2.0,14.0)d(范围1~30 d),术后中位恢复用药时间为4.0(3.0,7.0)d(范围1~14 d)。停药组与未停药组患者术后2周内发生出血(10/37比8/20,χ^(2)=1.011,P=0.315)及心脑血管事件(4/37比0/20,校正后χ^(2)=0.964,P=0.326)的差异均无统计学意义。多因素Logistic回归分析结果显示,术前停用抗凝或抗血小板药物不是术后发生出血事件的独立影响因素(OR=0.656,95%CI 0.195~2.206,P=0.496),而术前服用阿司匹林+氯吡格雷为术后出血事件的独立影响因素(OR=4.038,95%CI 1.044~15.626,P=0.043)。术后4例心脑血管事件均发生在停药组,术前6个月内有不稳定心绞痛病史(OR=9.764,95%CI 0.928~102.682,P=0.058)、血钙升高(OR=1.491,95%CI 0.976~2.278,P=0.065)者术后发生心脑血管事件风险有增加趋势。结论腹透置管术前是否停用抗凝或抗血小板药物不是患者术后发生出血事件的影响因素,但需关注术前应用阿司匹林+氯吡格雷患者的术后出血风险。术前6个月内有不稳定心绞痛发作及高血钙的患者停药后发生心脑血管事件�Objective To analyze the effect of anticoagulant or antiplatelet drugs on bleeding and cardio-cerebral vascular events in perioperative period of catherization for peritoneal dialysis.Methods The clinical data of patients undergoing peritoneal dialysis catheterization in Peking University Third Hospital from July 1,2010 to December 31,2020 were collected and analyzed retrospectively.The patients were divided into drugs discontinuation group and drugs continuation group according to whether the anticoagulant drugs or antiplatelet drugs were discontinued or not.Baseline clinical data and bleeding and cardio-cerebral events after surgery were compared between the two groups.Multivariate logistic regression model was used to analyze the influencing factors for bleeding and cardio-cerebral events.Results A total of 57 patients were included in the study,with 34 males and 23 females.The age was(67.37±13.93)years old(range from 27 to 97 years old).There were 37 patients in drugs discontinuation group and 20 patients in drugs continuation group.The proportions of acute myocardial infarction events in drugs continuation group were higher than those in drugs discontinuation group in 3 months and 6 months before surgery(10/20 vs 3/37,χ^(2)=10.671,P=0.001;11/20 vs 3/37,χ^(2)=12.980,P<0.001 respectively).The median drugs discontinuation time was 5.0(2.0,14.0)d(range from 1 to 30 d)before surgery,and median restore medication time was 4.0(3.0,7.0)d(range from 1 to 14 d)after surgery in drugs discontinuation group.There was no significant difference in the proportion of bleeding(10/37 vs 8/20,χ^(2)=1.011,P=0.315)and cardio-cerebral events(4/37 vs 0/20,χ^(2)=0.964,P=0.326)between drugs discontinuation group and drugs continuation group within 2 weeks after surgery.The results of multivariate logistic regression analysis showed that drugs discontinuation before surgery was not an independent influencing factor for bleeding events(OR=0.656,95%CI 0.195-2.206,P=0.496),however combination of aspirin and clopidogrel before surger

关 键 词：腹膜透析 血小板聚集抑制剂 抗凝血酶类 围手术期 出血事件 心脑血管事件 

分 类 号：R692.5[医药卫生—泌尿科学]