冠脉支架置入后行胃癌根治术病人围手术期抗栓治疗方案疗效对比研究  

Comparison of perioperative antithrombotic therapy in patients undergoing radical gastric cancer after coronary stent implantation

作　　者：徐子尧 郝新宇 袁晓航 吴迪 李硕 高磊 王鑫鑫 XU Zi-yao;HAO Xin-yu;YUAN Xiao-hang(Department of General Surgery,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心普通外科医学部,北京100853 [2]中国人民解放军总医院第一医学中心麻醉科,北京100853 [3]中国人民解放军总医院第六医学中心心血管病医学部,北京100048

出　　处：《中国实用外科杂志》2023年第9期1021-1026,1032,共7页Chinese Journal of Practical Surgery

基　　金：北京市科技计划课题项目(No.Z201110008320023)。

摘　　要：目的 比较围手术期不同抗栓治疗方案对合并冠脉支架置入的胃癌病人术后主要不良心血管事件(MACE)和出血事件的发生及相关影响因素,为合理选择抗栓用药方案提供依据。方法 回顾性分析2017年1月至2021年12月中国人民解放军总医院第一医学中心普通外科医学部收治的冠脉支架置入术后1年内行胃癌根治术病人的临床资料,根据围手术期抗栓用药方案分为阿司匹林组(持续使用阿司匹林100 mg/d),桥接治疗组(给予阿司匹林75 mg/d+达肝素钠2500 U/d)。比较两组病人的一般资料、临床病理特征、术前心脏及凝血、手术等相关指标、MACE及出血事件的发生率。采用Logistic回归分析探讨MACE及出血事件的影响因素。结果 共纳入268例病人,其中阿司匹林组84例(31.4%),桥接治疗组184例(68.6%)。两组病人一般资料、临床病理特征、术前心脏及凝血指标差异无统计学意义(P>0.05)。两组首次排气时间、引流管拔除时间、总住院时长差异无统计学意义(P>0.05)。阿司匹林组手术时长、术中失血量低于桥接治疗组,术后进入重症监护室的发生率高于桥接治疗组,差异有统计学意义(P<0.05)。阿司匹林组病人MACE总发生率高于桥接治疗组,差异有统计学意义(34.5%vs. 22.8%,P<0.05);亚组分析显示阿司匹林组心绞痛发生率高于桥接治疗组(15.5%vs. 6.5%,P<0.05)。两组出血学术研究会(BARC)1型、2型、3型出血事件发生率差异均无统计学意义(P>0.05)。年龄≥65岁、美国麻醉医师协会(ASA)分级Ⅲ/Ⅳ级是术后出血事件的独立危险因素(P<0.05),抗栓治疗方案并不是影响术后出血事件发生的独立危险因素。桥接治疗、吸烟史、高血压、支架数量、冠脉支架植入术后到胃癌根治术的时间及支架置入部位与病人术后出现MACE可能有关(P<0.05),多因素Logistics分析显示桥接治疗是术后MACE的独立保护因素(OR:0.132,95%CI:0.095~0.337,P<0.01)�Objective Comparing the incidence of major adverse cardiovascular events and bleeding events and related factors in patients with gastric cancer with coronary stent implantation with different antithrombotic treatment regimes during perioperative period,it provides an important reference for the rational selection of antithrombotic treatment regimens.Methods A retrospective analysis of clinical data from patients admitted to the Department of General Surgery,the First Medical Center,People's Liberation Army General Hospital,China,between January 2017 and December 2021 who underwent radical gastric cancer surgery within 1 year of coronary stent implantation was conducted.Patients were divided into aspirin groups(continuous aspirin use of 100 mg/d)and bridging therapy groups(administration of aspirin 75 mg/d plus heparin 2500 U/d)based on perioperative antithrombotic regimens.The baseline,clinicopathologic features,preoperative cardiac and coagulation,surgical parameters,MACE and incidence of bleeding events were compared between the two groups.Logistic regression analysis was used to investigate the influence of MACE and bleeding events.Results A total of 268 patients were included,including 84 in the aspirin group(31.4%)and 184 in the bridging group(68.6%).There was no statistically significant difference in general data,clinicopathologic features,preoperative cardiac and coagulation indices between the two groups(P>0.05).There was no statistically significant difference between the two groups in the time of first venting,time of drainage and length of total hospitalization(P>0.05).Patients in the aspirin group had a significantly lower incidence of long-term,intraoperative blood loss than those in the bridge-treated group,and a statistically significant difference(P<0.05)in the incidence of postoperative admission to ICU compared to those in the bridge-treated group.The overall incidence of MACE was higher in the aspirin group than in the bridge-treated group,with statistically significant differences(34.5%vs.22

关 键 词：胃癌 冠脉支架置入术后 抗血小板药物治疗 主要不良心血管事件 

分 类 号：R6[医药卫生—外科学]