發(fā)布時間：2018-05-28 12:48

  本文選題：非體外循環(huán) + 冠狀動脈旁路移植術(shù)��； 參考：《天津醫(yī)科大學》2017年碩士論文

【摘要】：目的評估術(shù)前持續(xù)服用阿司匹林和氯吡格雷的雙聯(lián)抗血小板治療(Dual Antiplatelet Therapy,DAPT)對非體外循環(huán)下冠狀動脈旁路移植術(shù)(Off-Pump Coronary Artery Bypass Grafting,OPCABG)患者近期預(yù)后的影響。方法本研究為單中心觀察性研究。納入279例2015年1月至2016年5月期間在天津市胸科醫(yī)院進行初次單純非體外循環(huán)下心臟不停跳冠狀動脈旁路移植術(shù)的患者,按照術(shù)前雙聯(lián)抗血小板治療(DAPT)情況將其分成兩組:一組患者持續(xù)DAPT至術(shù)前1天DAPT組(n=148);另一組患者OPCABG術(shù)前停用DAPT5天(對照組,n=131)。搜集兩組患者基線資料,術(shù)后總引流量、出血剖胸探查發(fā)生率、血制品輸注以及其他住院期間的臨床結(jié)果資料進行比較和統(tǒng)計學分析。結(jié)果兩組患者人口學特征和臨床基線資料無顯著差異。DAPT組患者在術(shù)后總的胸腔引流量(DAPT組vs.對照組,899±227 m L vs.801±242 m L,P=0.001)和圍術(shù)期血制品輸注(包括輸血比例和輸血量)上都明顯高于對照組。兩組患者術(shù)后出血所致剖胸探查發(fā)生率(DAPT組vs.對照組,3.4%vs.0.8%,P=0.219),手術(shù)時間(DAPT組vs.對照組,4.93±0.69 vs.4.82±0.69,P=0.168),ICU停留時間(DAPT組vs.對照組,51.82±13.95 h vs.50.56±13.04 h,P=0.434),氣管內(nèi)插管時間(DAPT組vs.對照組,16.23±2.57 h vs.16.12±2.61 h,P=0.729),術(shù)后住院天數(shù)(DAPT組vs.對照組,10.6±5.4 d vs.9.6±4.8 d,P=0.108),術(shù)后非致死性心肌梗死發(fā)生率(DAPT組vs.對照組,4.7%vs.3.8%,P=0.708)均無明顯統(tǒng)計學差異。術(shù)后住院期間未觀察到卒中和其他嚴重的胸外出血,兩組患者術(shù)后住院期間均無死亡病例。結(jié)論OPCABG患者術(shù)前持續(xù)服用雙聯(lián)抗血小板治療會增加術(shù)后胸腔引流液和血制品輸注需求但不具有顯著臨床意義。雙聯(lián)抗血小板治療持續(xù)至術(shù)前不增加出血剖胸探查發(fā)生率,不影響OPCABG患者的近期預(yù)后和術(shù)后恢復(fù)。如果臨床情況許可,擬行初次單純OPCABG的患者術(shù)前持續(xù)服用雙聯(lián)抗血小板藥物是安全的。這一抗血小板治療方案的長期臨床結(jié)果則需要更大樣本的多中心隨機對照試驗進一步評估。
[Abstract]:Objective to evaluate the effect of dual antiplatelet therapy with aspirin and clopidogrel on the short term prognosis of Off-Pump Coronary Artery Bypass grafting (OPCABG) patients after off-pump coronary artery bypass grafting (CABG). Methods this study was a monocentric observational study. From January 2015 to May 2016, 279 patients underwent coronary artery bypass grafting (CABG) at Tianjin chest Hospital for the first time without cardiopulmonary bypass. According to the condition of dual antiplatelet therapy before operation, the patients were divided into two groups: one group was treated with DAPT until one day before operation, and the other group with OPCABG was stopped for DAPT5 day before operation (control group). The baseline data of the two groups, the total drainage, the incidence of bleeding thoracotomy, the blood product infusion and other clinical data during hospitalization were compared and statistically analyzed. Results there was no significant difference in demographic characteristics and clinical baseline data between the two groups. In the control group (899 鹵227ml vs.801 鹵242ml) and perioperative transfusion of blood products (including blood transfusion ratio and transfusion volume) were significantly higher than those in the control group. The incidence of thoracotomy caused by postoperative bleeding in both groups was higher than that in DAPT group. The control group (3.4vs.0.8vs 0.219g) and the DAPT group (Vs0.219g). The control group (4.93 鹵0.69 vs.4.82 鹵0.69 vs.4.82 鹵0.168 vs.4.82) and the DAPT group had a time of stay in ICU. The control group was 51.82 鹵13.95 h vs.50.56 鹵13.04 h, the endotracheal intubation time of DAPT group was 0.434.The time of endotracheal intubation in DAPT group was higher than that in DAPT group. The control group was 16.23 鹵2.57h vs.16.12 鹵2.61h, and the days of postoperative hospitalization were significantly higher than that of DAPT group (vs). The control group was 10.6 鹵5.4d vs.9.6 鹵4.8dPU 0.108g, and the incidence of postoperative non-fatal myocardial infarction was higher than that of DAPT group. There was no significant difference between the control group (4.7vs.3.8) and the control group (0.708). No stroke or other severe extrathoracic hemorrhage was observed during hospitalization, and there were no death cases in both groups. Conclusion continuous administration of dual antiplatelet therapy before operation in patients with OPCABG may increase the need for postoperative pleural drainage and transfusion of blood products, but it has no significant clinical significance. Dual antiplatelet therapy did not increase the incidence of bleeding thoracotomy before operation, and did not affect the short-term prognosis and postoperative recovery of patients with OPCABG. If clinical conditions permit, it is safe for first-time OPCABG patients to continue to take dual antiplatelet drugs before operation. The long-term clinical results of this anti-platelet regimen require further evaluation in a larger sample of multicenter randomized controlled trials.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R654.2

【參考文獻】

相關(guān)期刊論文 前3條

1 Vincenzo Tarzia;Giacomo Bortolussi;Edward Buratto;Carla Paolini;Carlo Dal Lin;Giulio Rizzoli;Tomaso Bottio;Gino Gerosa;;Single vs double antiplatelet therapy in acute coronary syndrome: Predictors of bleeding after coronary artery bypass grafting[J];World Journal of Cardiology;2015年09期

2 Shahzad G Raja;Umberto Benedetto;;Off-pump coronary artery bypass grafting: Misperceptions and misconceptions[J];World Journal of Methodology;2014年01期

3 Xuezhong Wang;Xiaoxuan Gong;Tiantian Zhu;Qiu Zhang;Yangyang Zhang;Xiaowei Wang;Zhijian Yang;Chunjian Lia;;Clopidogrel improves aspirin response after off-pump coronary artery bypass surgery[J];Journal of Biomedical Research;2014年02期

，

本文編號：1946753