未停用雙聯(lián)抗血小板藥物治療（DAPT）冠心病患者行非體外循環(huán)冠脈搭橋術（OPCABG）的安全性研究
發(fā)布時間：2019-06-12 06:42
【摘要】：目前,隨著社會人口老齡化日益加劇,人們飲食結構的逐漸改變,生活水平的逐漸提升,心血管疾病已成為威脅大眾生命安全的重大隱患,而急性冠脈綜合征又是心血管疾病中最危急也是最威脅人們生命安全的。隨著外科技術的逐漸成熟,冠狀動脈旁路移植術(coronary artery bypass grafting,CABG)和心導管介入治療已被廣泛應用于治療急性冠脈綜合征和嚴重慢性冠狀動脈粥樣硬化。鑒于非體外循環(huán)冠狀動脈旁路移植術(off-pump coronary artery bypass grafting,OPCABG)對于減少體外循環(huán)并發(fā)癥以及縮短手術時間上都有明顯的優(yōu)勢,對患者的預后有積極的作用,所以非體外循環(huán)冠狀動脈旁路移植術(OPCABG)越來越被各大醫(yī)院所認可,成為臨床外科治療冠心病的主要方式。目的:通過對雙聯(lián)抗血小板藥物治療(DAPT)冠心病患者行非體外循環(huán)冠狀動脈旁路移植術(OPCABG)圍術期各項指標的觀察,對術前未常規(guī)停用DAPT冠心病患者圍術期的安全性進行評估。從而為行急診冠脈搭橋術患者提供更安全的圍術期指導,并為其安全帶來更有力的理論支持。方法:研究對象選擇2014年11月~2017年1月在河北醫(yī)科大學第二醫(yī)院心臟外科行OPCABG的患者200例,按照其術前是否停用雙聯(lián)抗血小板藥物一周以上分為對照組(N組)及觀察組(B組),持續(xù)監(jiān)測并記錄患者從入室到出室的收縮壓(SBP)、舒張壓(DBP)、平均動脈壓(MAP)、BIS值、心率(HR)及中心靜脈壓(CVP)等相關血流動力學參數;記錄兩組術中及術后出血及輸血以及患者轉歸指標,并對各項指標進行統(tǒng)計,最終得出結論。結果：1 N組與B組在年齡、身高及各項基礎生命體征上的差異無統(tǒng)計學意義(P0.05)。2 N組與B組從入室到出室的各個時間點的相關血流動力學指標的差異無統(tǒng)計學意義(P0.05)。3 N組與B組的術中出血量分別為(758.00±476.06)ml和(1016.55±597.98)ml,組間對比有統(tǒng)計學意義(P0.05)。4 N組與B組的術中自體血回輸血量分別為(407.53±224.43)ml和(548.67±310.55)ml,組間對比有統(tǒng)計學意義(P0.05)。5 N組與B組的術后引流量分別為(337.15±162.01)ml和(393.75±211.42)ml,組間對比有統(tǒng)計學意義(P0.05)。6 N組與B組術后清醒時間,拔管時間,術后ICU停留時間,住院時間組間對比沒有統(tǒng)計學差異(P0.05)。7 N組與B組術中輸入異體血量(RBC,血漿,冷沉淀)差異有統(tǒng)計學意義(P0.05)。8 N組與B組的術中輸入異體血的比率除冷沉淀有差異有統(tǒng)計學意義(P0.05)外,RBC與血漿差異均無統(tǒng)計學意義(P0.05)。9 N組與B組術后輸入異體血量中冷沉淀以及血小板差異無統(tǒng)計學意義(P0.05),而RBC與血漿差異有統(tǒng)計學意義(P0.05)。10 N組與B組術后輸入異體血的比率與輸入血量相同,冷沉淀以及血小板差異沒有統(tǒng)計學意義,而RBC與血漿差異有統(tǒng)計學意義(P0.05)。結論：1未停用雙聯(lián)抗血小板藥物治療(DAPT)冠心病患者行非體外循環(huán)冠脈搭橋術(OPCABG)相較于術前停用DAPT冠心病患者,術中出血量、術中輸血率有明顯增加,為術中管理增加了難度,但是術中血流動力學參數相較對照組,沒有明顯差異,說明DAPT冠心病患者術中完全可以保證患者生命體征的平穩(wěn)。2未停用雙聯(lián)抗血小板藥物治療(DAPT)冠心病患者行非體外循環(huán)冠脈搭橋術(OPCABG)相較于術前停用DAPT冠心病患者而言,術后引流量及術后輸血率也有所增加,為臨床對其術后管理提供了依據。3未停用雙聯(lián)抗血小板藥物治療(DAPT)冠心病患者行非體外循環(huán)冠脈搭橋術(OPCABG)相較于術前停用DAPT冠心病患者而言,ICU停留時間以及住院時間并未有明顯延長,故而為日后急診行冠脈搭橋術的患者的安全性提供了有力的理論依據。
[Abstract]:At present, as the population aging is increasing, people's diet structure gradually changes, the living standard gradually increases, the cardiovascular disease has become a major hidden danger to the life safety of the public, Acute coronary syndrome, in turn, is the most critical of cardiovascular disease and is the most dangerous for people. With the gradual maturation of surgical techniques, coronary artery bypass grafting (CABG) and cardiac catheterization have been widely used in the treatment of acute coronary syndrome and severe chronic coronary atherosclerosis. In view of the significant advantages of off-pump coronary artery bypass grafting (OPCABG) in reducing the complications of cardiopulmonary bypass and shortening the time of operation, the prognosis of patients has a positive effect on the prognosis of patients. Therefore, the off-pump coronary artery bypass grafting (OPCABG) is more and more accepted by the major hospitals, and has become the main way of clinical surgery in the treatment of coronary heart disease. Objective: To evaluate the perioperative safety of DAPT coronary artery bypass grafting (OPCABG) in patients with coronary artery bypass grafting (DAPT) coronary artery bypass grafting (OPCABG) in patients with coronary heart disease (DAPT). So as to provide more safe perioperative guidance for patients with emergency coronary artery bypass surgery and provide more powerful theoretical support for the safety of the patients. Methods:200 patients with OPCABG in the second hospital of Hebei Medical University from November 2014 to January 2017 were selected and divided into the control group (N group) and the observation group (group B) according to whether the double antiplatelet drugs were used for more than a week before the operation. The relevant hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), BIS value, heart rate (HR) and central venous pressure (CVP) of the patient from the chamber to the outlet chamber were continuously monitored and recorded, and the two groups were recorded and post-operative bleeding and blood transfusion and the patient outcome index, And the indexes are counted, and finally the conclusions are finally drawn. Results: The age of the 1N and the B groups, There was no significant difference between the height and the basic vital signs (P0.05). There was no significant difference between the two groups (P0.05). The amount of blood loss in the 3 N and B groups was (758.00, 476.06) ml and (1016.55, 597.98) ml, respectively. There was a significant difference between the group and group B (P0.05). The amount of blood transfusion in the 4 N and B groups was (407.53, 224.43) ml and (548.67, 310.55) ml, respectively, and there was a significant difference between the groups (P0.05). The postoperative drainage rates of the 5N and group B groups were (337.15-162.01) ml and (393.75-211.42) ml, respectively. There was no statistical difference between the group and group B (P0.05). There was no statistical difference between group B and group B after operation (P0.05). The amount of allogenic blood (RBC, plasma, The difference of cold precipitation was statistically significant (P0.05). There was a significant difference in the ratio of blood to cold precipitation in the group of 8N and group B (P0.05). There was no significant difference between RBC and plasma (P0.05). There was no significant difference in the difference of RBC and plasma (P0.05). The difference of RBC and plasma was significant (P0.05). The ratio of input blood to blood in group 10N and group B was the same as that of the input blood. There was no statistical significance between cold precipitation and platelet difference, and the difference of RBC and plasma was significant (P0.05). Conclusion:1 The patients with coronary heart disease (DAPT) with coronary heart disease (DAPT) with coronary heart disease (DAPT) with coronary artery bypass (OPCABG) were treated with no-pump coronary artery bypass (OPCABG). but the hemodynamic parameters in the operation were not significantly different compared to the control group, The treatment of DAPT coronary heart disease (DAPT) with coronary artery bypass (OPCABG) in patients with coronary heart disease (DAPT) was not stopped and the patients with DAPT coronary heart disease were discontinued before operation. The postoperative drainage and post-operative blood transfusion rate were also increased, which provided a basis for the postoperative management of patients with coronary heart disease (DAPT). The stay time of the ICU and the hospital stay time were not significantly prolonged, thus providing a strong theoretical basis for the safety of the patients who underwent coronary artery bypass surgery in the future.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2
本文編號：2497817
[Abstract]:At present, as the population aging is increasing, people's diet structure gradually changes, the living standard gradually increases, the cardiovascular disease has become a major hidden danger to the life safety of the public, Acute coronary syndrome, in turn, is the most critical of cardiovascular disease and is the most dangerous for people. With the gradual maturation of surgical techniques, coronary artery bypass grafting (CABG) and cardiac catheterization have been widely used in the treatment of acute coronary syndrome and severe chronic coronary atherosclerosis. In view of the significant advantages of off-pump coronary artery bypass grafting (OPCABG) in reducing the complications of cardiopulmonary bypass and shortening the time of operation, the prognosis of patients has a positive effect on the prognosis of patients. Therefore, the off-pump coronary artery bypass grafting (OPCABG) is more and more accepted by the major hospitals, and has become the main way of clinical surgery in the treatment of coronary heart disease. Objective: To evaluate the perioperative safety of DAPT coronary artery bypass grafting (OPCABG) in patients with coronary artery bypass grafting (DAPT) coronary artery bypass grafting (OPCABG) in patients with coronary heart disease (DAPT). So as to provide more safe perioperative guidance for patients with emergency coronary artery bypass surgery and provide more powerful theoretical support for the safety of the patients. Methods:200 patients with OPCABG in the second hospital of Hebei Medical University from November 2014 to January 2017 were selected and divided into the control group (N group) and the observation group (group B) according to whether the double antiplatelet drugs were used for more than a week before the operation. The relevant hemodynamic parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), BIS value, heart rate (HR) and central venous pressure (CVP) of the patient from the chamber to the outlet chamber were continuously monitored and recorded, and the two groups were recorded and post-operative bleeding and blood transfusion and the patient outcome index, And the indexes are counted, and finally the conclusions are finally drawn. Results: The age of the 1N and the B groups, There was no significant difference between the height and the basic vital signs (P0.05). There was no significant difference between the two groups (P0.05). The amount of blood loss in the 3 N and B groups was (758.00, 476.06) ml and (1016.55, 597.98) ml, respectively. There was a significant difference between the group and group B (P0.05). The amount of blood transfusion in the 4 N and B groups was (407.53, 224.43) ml and (548.67, 310.55) ml, respectively, and there was a significant difference between the groups (P0.05). The postoperative drainage rates of the 5N and group B groups were (337.15-162.01) ml and (393.75-211.42) ml, respectively. There was no statistical difference between the group and group B (P0.05). There was no statistical difference between group B and group B after operation (P0.05). The amount of allogenic blood (RBC, plasma, The difference of cold precipitation was statistically significant (P0.05). There was a significant difference in the ratio of blood to cold precipitation in the group of 8N and group B (P0.05). There was no significant difference between RBC and plasma (P0.05). There was no significant difference in the difference of RBC and plasma (P0.05). The difference of RBC and plasma was significant (P0.05). The ratio of input blood to blood in group 10N and group B was the same as that of the input blood. There was no statistical significance between cold precipitation and platelet difference, and the difference of RBC and plasma was significant (P0.05). Conclusion:1 The patients with coronary heart disease (DAPT) with coronary heart disease (DAPT) with coronary heart disease (DAPT) with coronary artery bypass (OPCABG) were treated with no-pump coronary artery bypass (OPCABG). but the hemodynamic parameters in the operation were not significantly different compared to the control group, The treatment of DAPT coronary heart disease (DAPT) with coronary artery bypass (OPCABG) in patients with coronary heart disease (DAPT) was not stopped and the patients with DAPT coronary heart disease were discontinued before operation. The postoperative drainage and post-operative blood transfusion rate were also increased, which provided a basis for the postoperative management of patients with coronary heart disease (DAPT). The stay time of the ICU and the hospital stay time were not significantly prolonged, thus providing a strong theoretical basis for the safety of the patients who underwent coronary artery bypass surgery in the future.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2
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