冠心病患者PCI术中肝素用量对出血的影响及脑微出血数量在预测出血中的作用  

The effect of heparin dosage during PCI in patients with coronary heart disease on bleeding and the role of CMBs in predicting bleeding

作　　者：边毓尧 修明文 侯婧 何淼 饶世俊 BIAN Yuyao;XIU Mingwen;HOU Jing;HE Miao;RAO Shijun(Department of Emergency Medicine,Hebei Petro China Central Hospital,Langfang Hebei 065000,China)

机构地区：[1]河北中石油中心医院急诊科,河北廊坊065000

出　　处：《中国急救复苏与灾害医学杂志》2022年第6期710-714,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：河北省重点研发计划自筹项目(编号:182777143)

摘　　要：目的 探讨经皮冠状动脉介入(PCI)治疗患者术后出血的危险因素及脑微出血(CMBs)数量在预测PCI后出血中的作用。方法 选取2019年9月-2020年4月河北中石油中心医院急诊科收治的PCI患者54例为研究对象。根据患者PCI手术过程中肝素使用量分为高剂量组(100 U/kg)、低剂量组(70 U/kg),收集PCI患者术前血小板计数、凝血酶原时间、抗凝血酶Ⅲ、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、血小板聚集率等指标,进行Crusade出血评分并计算出血率;术后72 h再次收集上述指标及术中肝素使用量;术后72 h对所有患者行磁敏感加权成像(SWI)检查,计算CMBs数量;收集术后1周内出血患者出血部位、出血量,根据患者是否出血分为出血组和无出血组,比较两组观察指标。根据患者手术次数分为一次手术组和二次手术组,比较两组患者以上指标差异。统计CMBs数量与各观察指标相关性,采用Logistic回归分析影响PCI患者出血的危险因素,比较其对PCI患者出血的判断价值。结果 肝素高剂量组CMBs、支架数量、Cr清除率(术前)、Cr清除率(术后72 h)水平高于低剂量组,差异均有统计学意义(P<0.05)。出血组与未出血组比较,出血组血浆Cr(术前)、Glu(术前)、血小板聚集率(AA,术前)、肝素量、CMBs高于未出血组,差异有统计学意义(P<0.05)。二次手术组患者CMBs、Crusade评分(一次和二次术前)高于一次手术组,差异均有统计学意义(P<0.05)。Spearman’s相关分析显示,CMBs数量与肝素量呈正相关(r=0.348,P=0.01)。Cr(术前)、肝素量、CMBs为影响PCI患者出血的独立危险因素。术前Cr曲线下面积为0.700,肝素曲线下面积为0.702,CMBs曲线下面积为0.852。结论 CMBs数量对PCI患者出血的判断有预测价值;术前肌酐高、术中肝素使用剂量多的PCI患者出血风险增加。Objective To explore the risk factors of postoperative bleeding in PCI patients and the role of CMBs in predicting postoperative bleeding after coronary intervention.Methods 54 PCI patients admitted to the emergency department of Hebei PetroChina Central Hospital from September 2019 to April 2020 were selected as the research objects. According to the amount of heparin used during PCI surgery, patients were divided into two groups: high-dose group(100 U/kg) and low-dose group(70 U/kg). The preoperative platelet count, prothrombin time, antithrombin Ⅲ, of the PCI patients were collected. Activate partial thromboplastin time(APTT), prothrombin time(PT), platelet aggregation rate and other indicators, perform Crusade bleeding score and calculate bleeding rate;collect the above indicators and intraoperative heparin consumption again 72 hours after surgery;for all The patients underwent SWI examination 72 hours after operation to calculate the number of CMBs;the bleeding site and amount of bleeding patients within 1 week after the operation were collected, and the patients were divided into bleeding group and nonbleeding group according to whether the patients were bleeding, and the observation indicators of the two groups were compared. According to the number of operations, the patients were divided into the first operation group and the second operation group. Count the correlation between the number of CMBs and each observation index, and use Logistic regression to analyze the risk factors that affect the bleeding of PCI patients, and compare their value in judging the bleeding of PCI patients.Results The levels of CMBs, number of stents, Cr clearance(preoperatively) and Cr clearance(72 h postoperative) in the high-dose heparin group were higher than those in the low-dose group, and the differences were statistically significant(P<0.05). Compared with the non-bleeding group, the blood plasma Cr(preoperative), Glu(preoperative), AA(preoperative), heparin amount, and CMBs in the bleeding group were higher than tho

关 键 词：经皮冠状动脉介入 磁敏感加权成像 脑微出血 出血 Crusade出血评分 

分 类 号：R541.4[医药卫生—心血管疾病]