本文選題：阿司匹林　切入點(diǎn)：神經(jīng)外科　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:阿司匹林作為血小板聚集抑制劑,目前已廣泛用于預(yù)防中老年人的心腦血管疾病。然而,近來研究顯示,阿司匹林具有導(dǎo)致出血的潛在風(fēng)險(xiǎn),能增加自發(fā)性顱內(nèi)出血危險(xiǎn)性,是出血后近期死亡的獨(dú)立預(yù)測(cè)指標(biāo),那么,術(shù)前長(zhǎng)期服用阿司匹林可能增加顱腦手術(shù)術(shù)后顱內(nèi)出血的風(fēng)險(xiǎn)。本研究的目的是:探討術(shù)前長(zhǎng)期服用阿司匹林對(duì)中老年患者顱腦外科擇期手術(shù)術(shù)后顱內(nèi)出血等的影響,為改進(jìn)臨床工作提供參考。方法:收集吉林大學(xué)第一醫(yī)院神經(jīng)腫瘤外科2016年1月至2016年9月583例患者,對(duì)患者病史、影像學(xué)資料、手術(shù)記錄、術(shù)后病程進(jìn)行回顧性分析。按照納入標(biāo)準(zhǔn),最后171例患者作為研究對(duì)象。將未服用阿司匹林的患者列為對(duì)照組,長(zhǎng)期服用阿司匹林的患者列為實(shí)驗(yàn)組。主要對(duì)長(zhǎng)期口服阿司匹林藥物史、術(shù)前凝血常規(guī)及血小板凝集功能檢查、術(shù)后CT檢測(cè)是否出血及出血量、死亡率及出院時(shí)日常生活活動(dòng)能力(ADL)分級(jí)、住院天數(shù)及術(shù)前、術(shù)后3天血紅蛋白含量等進(jìn)行分析。實(shí)驗(yàn)組在復(fù)查血小板凝集功能正常后實(shí)施手術(shù)。最后收集兩組患者術(shù)后出血、術(shù)后血紅蛋白含量、死亡率、出院時(shí)日常生活活動(dòng)能力(ADL)分級(jí)、住院天數(shù)、術(shù)前及術(shù)后3天血紅蛋白含量情況,并采用SPSS 22.0進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:對(duì)照組(術(shù)前未服用阿司匹林)共143例,男性患者55例(32.2%),平均年齡為(56.4?6.7)歲,女性患者88例(51.2%),平均年齡(55.7?6.2)歲。實(shí)驗(yàn)組(術(shù)前服用阿司匹林超過1個(gè)月)共28例,男性患者12例(7.0%),平均年齡為(61.8?6.5)歲,女性患者16例(9.4%),平均年齡為(60.6?5.4)歲。研究結(jié)果表明,兩組患者術(shù)后出血率無統(tǒng)計(jì)學(xué)意義(T=-0.160,P=0.8730.05)。兩組患者出院時(shí)ADL評(píng)分無統(tǒng)計(jì)學(xué)意義(Z=-1.934,P=0.0530.05)。兩組患者的死亡率均為0%。兩組患者術(shù)前與術(shù)后3天血紅蛋白含量差值具有統(tǒng)計(jì)學(xué)意義(T=-3.499,P=0.010.05),表明術(shù)前長(zhǎng)期服用阿司匹林的患者術(shù)后有隱性失血。術(shù)前長(zhǎng)期服用阿司匹林的患者住院天數(shù)明顯長(zhǎng)于未服用阿司匹林的患者(T=-1.981,P=0.490.05)。結(jié)論:1.術(shù)前長(zhǎng)期服用阿司匹林的神經(jīng)外科擇期手術(shù)的患者,待其血小板凝集功能恢復(fù)正常后進(jìn)行手術(shù),手術(shù)出血率及出院時(shí)ADL評(píng)分與未服用阿司匹林的患者無統(tǒng)計(jì)學(xué)意義。2,術(shù)前長(zhǎng)期服用阿司匹林的神經(jīng)外科擇期手術(shù)的患者,待其血小板凝集功能恢復(fù)正常后實(shí)施手術(shù),隱性失血及住院天數(shù)均比未服用阿司匹林的患者增多。
[Abstract]:Objective: aspirin, as an inhibitor of platelet aggregation, has been widely used to prevent cardiovascular and cerebrovascular diseases in middle-aged and elderly people. However, recent studies have shown that aspirin has the potential to cause bleeding. It can increase the risk of spontaneous intracranial hemorrhage and is an independent predictor of short-term mortality after hemorrhage. The aim of this study was to investigate the effect of long-term aspirin on intracranial hemorrhage after selective craniocerebral surgery in middle-aged and elderly patients before and after craniocerebral surgery. Methods: from January 2016 to September 2016, we collected 583 patients from the Department of Neurooncology, the first Hospital of Jilin University. The course of the disease was analyzed retrospectively. According to the inclusion criteria, 171 patients were included in the study. The patients who did not take aspirin were included as the control group. The patients who took aspirin for a long time were included in the experimental group. The patients were given long-term oral aspirin drug history, blood coagulation routine before operation and platelet agglutination function examination, and CT examination after operation was used to detect bleeding and bleeding volume. The mortality and ADL grade, the days of hospitalization and the hemoglobin content before operation and 3 days after operation were analyzed. The patients in the experimental group were operated on after checking the platelet agglutination function. Finally, the patients in the two groups received postoperative bleeding. Hemoglobin content, mortality rate, ADL grade at discharge, hospitalization days, hemoglobin content before and 3 days after operation, SPSS 22.0 was used for statistical analysis. Results: there were 143 cases in control group (without aspirin before operation) and 55 cases in male patients (mean age was 56.4? 6. 7 years old, 88 cases of female patients with 51.2%, mean age of 55.7? 6. 2 years old. There were 28 patients in the experimental group (taking aspirin for more than 1 month before operation) and 12 male patients (mean age was 61.8? 6.5 years old, 16 female patients with an average age of 60.6? 5.4 years of age. The results of the study show that. There was no significant difference in postoperative bleeding rate between the two groups. There was no significant difference in ADL score at discharge between the two groups. The mortality rate of both groups was 0. The difference of hemoglobin content between preoperative and postoperative 3 days was statistically significant. The results showed that the patients who had taken aspirin for a long time before operation had recessive blood loss after operation. The days of hospitalization of the patients who took aspirin for a long time before operation were significantly longer than that of patients without aspirin. Conclusion: 1. Patients undergoing elective neurosurgery, When the platelet agglutination function returned to normal, the bleeding rate and the ADL score at discharge had no significant difference with those of the patients without aspirin, and the patients who had taken aspirin for a long time before operation were selected for neurosurgery. When the platelet agglutination function returned to normal, the recessive blood loss and hospitalization days were more than those without aspirin.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.1

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