术前抗凝抗血小板治疗方案和术后压迫制动时间对永久性起搏器植入患者术后出血的影响  

作　　者：方建梅[1] 郑铱焓 丁恒[1] 陈丽微 张莉莉[1] 张万里 

机构地区：[1]温州医科大学附属第一医院,325000 [2]浙江省温州市龙湾区第一人民医院,325000

出　　处：《浙江临床医学》2025年第2期283-285,共3页Zhejiang Clinical Medical Journal

基　　金：温州市基础性医疗卫生科技项目(Y2020689)。

摘　　要：目的探讨术前抗凝抗血小板治疗和术后压迫制动时间对永久性起搏器植入患者术后出血事件的影响。方法回顾性分析671例永久性起搏器植入患者,根据是否使用抗凝抗血小板治疗将患者分为A组(无抗凝抗血小板治疗)、B组(抗凝治疗)和C组(抗血小板治疗);根据术后压迫制动时间将患者分为<2 h组、3~10 h组和≥11 h组;并根据药物剂量、INR水平等进一步细分亚组,分析各组出血事件的概率。结果术前不同抗凝抗血小板治疗方案(χ^(2)=3.086,P=0.214)和术后压迫制动时间(χ^(2)=4.176,P=0.124)与患者术后出血事件概率的差异无统计学意义。利伐沙班不同剂量(χ^(2)=2.999,P=0.223)和华法林INR不同水平(χ^(2)=2.843,P=0.092)的患者出血事件概率差异无统计学意义。服用双抗血小板药物患者比单抗血小板药物患者发生出血事件的概率高,差异有统计学意义(χ^(2)=12.122,P=0.002)。结论术前使用不同抗凝抗血小板治疗方案和术后压迫制动时间对永久性起搏器植入患者发生出血事件概率差异无统计学意义,提示术前抗凝抗血小板药物使用和适当缩短压迫制动时间不会增加出血事件发生概率。Objective To investigate the impact of preoperative anticoagulant and antiplatelet treatment regimens and postoperative compression immobilization time on postoperative bleeding events in patients with permanent pacemaker implantation.Methods A retrospective analysis was conducted on 671 patients who underwent permanent pacemaker implantation,divided into Group A(no anticoagulant or antiplatelet treatment),Group B(anticoagulant treatment),and Group C(antiplatelet treatment);patients were further divided into subgroups based on postoperative compression immobilization time into≤2 h,3~10 h,and≥11 h groups;patients were further subdivided into subgroups based on drug dosage and INR levels;the probability of bleeding events in each group was analyzed.Results There was no statistically significant difference in the probability of postoperative bleeding events between different preoperative anticoagulant and antiplatelet treatment regimens(χ^(2)=3.086,P=0.214)and postoperative compression immobilization time(χ^(2)=4.176,P=0.124).There was no statistically significant difference in the probability of bleeding events among patients with different dosages of rivaroxaban(χ^(2)=2.999,P=0.223)and different INR levels of warfarin(χ^(2)=2.843,P=0.092).The probability of bleeding events in patients taking dual antiplatelet therapy was higher than those taking single antiplatelet therapy,with a statistically significant difference(χ^(2)=12.122,P=0.002).Conclusion There is no statistical difference in the probability of postoperative bleeding events in patients with permanent pacemaker implantation using different anticoagulant and antiplatelet therapy regimens before operation and postoperative compression and immobilization time,suggesting that the use of preoperative anticoagulant and antiplatelet drugs and appropriate reduction of compression immobilization time will not increase the probability of bleeding events.

关 键 词：抗凝抗血小板治疗 永久性起搏器植入 制动时间 出血事件 

分 类 号：R54[医药卫生—心血管疾病]