本文選題：左主干病變 + 冠脈搭橋術(shù)��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)價(jià)冠脈高危左主干病變患者施行非體外循環(huán)冠脈搭橋術(shù)術(shù)前應(yīng)用抗血小板藥物對(duì)術(shù)后出血、輸血及并發(fā)癥的影響。方法:選取河北醫(yī)科大學(xué)第二醫(yī)院心臟大血管外科2015年至2016年期間行非體外循環(huán)冠脈搭橋術(shù)的115例冠脈高危左主干病變患者,依據(jù)中止雙聯(lián)抗血小板治療(阿司匹林+氯吡格雷)的時(shí)間,將患者分為術(shù)前停藥5d及5d以上組(A組)、術(shù)前停藥3~4d組(B組)、術(shù)前停藥1d組(C組)以及服藥至術(shù)日組(D組)。比較四組患者術(shù)后胸腔引流量、輸血量、不良心血管事件(急性心梗、死亡)、二次開(kāi)胸等情況。結(jié)果:1四組患者的基線(xiàn)資料包括年齡、性別、身高、體重、高血壓病史、高脂血癥病史、糖尿病病史、左室射血分?jǐn)?shù)、血紅蛋白、血小板計(jì)數(shù)等差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2四組患者手術(shù)時(shí)間、急性心梗發(fā)生率、二次開(kāi)胸發(fā)生率、住院死亡率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后24h引流量和術(shù)后總引流量有統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后24h引流量C組和D組明顯高于A組[(596.82±412.682)vs.(611.18±210.745)vs.(403.76±116.073)mL,P0.05],B組雖然高于A組,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后總引流量也是C組和D組明顯高于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3四組患者輸血漿比例和輸血漿量差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。四組患者均未輸血小板。C組和D組對(duì)紅細(xì)胞的需求量明顯高于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。D組對(duì)冷沉淀的需求量明顯高于A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:非體外循環(huán)冠脈搭橋術(shù)術(shù)前5d內(nèi)繼續(xù)應(yīng)用雙聯(lián)抗血小板藥物,會(huì)增加術(shù)后引流量及輸血量,但不增加嚴(yán)重出血風(fēng)險(xiǎn)及術(shù)后早期死亡率。對(duì)于擬行非體外循環(huán)冠脈搭橋術(shù)的冠脈高危左主干病變患者,應(yīng)該綜合考慮患者實(shí)際情況,必要時(shí)可縮短停藥時(shí)間。
[Abstract]:Objective: to evaluate the effects of antiplatelet drugs on postoperative bleeding, blood transfusion and complications in patients with high risk left main coronary artery disease after off-pump coronary artery bypass grafting. Methods: 115 patients with high risk coronary artery disease underwent off-pump coronary artery bypass grafting from 2015 to 2016 in Cardiovascular macrovascular surgery, second Hospital of Hebei Medical University. According to the time of discontinuation of dual antiplatelet therapy (clopidogrel aspirin), the patients were divided into three groups: group A (group A), group B (group B), group C (group C) and group D (group D). Chest drainage, blood transfusion, adverse cardiovascular events (acute myocardial infarction, death) and secondary thoracotomy were compared among the four groups. Results the baseline data of the four groups included age, sex, height, weight, history of hypertension, history of hyperlipidemia, history of diabetes, left ventricular ejection fraction, hemoglobin. There was no significant difference in platelet count (P0.05). 2 the time of operation, the incidence of acute myocardial infarction, the incidence of secondary thoracotomy, and the mortality rate of hospitalization were not significantly different among the four groups (P0.05). Postoperative 24 hours drainage volume and postoperative total drainage flow were statistically significant (P0.05). 24 hours after operation, the drainage volume in group C and group D was significantly higher than that in group A [(596.82 鹵412.682) vs. (, 611.18 鹵210.745) vs. (, 403.76 鹵116.073) vs. (, P0.05] although group B was higher than group A, the difference was not statistically significant (P0.05). Postoperative total drainage volume was significantly higher in group C and group D than in group A (P0.05). There was no significant difference in the proportion and volume of plasma transfusion among the four groups (P0.05). The demand for erythrocyte in group C and D was significantly higher than that in group A (P0.05). The demand for cryoprecipitation in group D was significantly higher than that in group A (P0.05). Conclusion: continuous use of dual antiplatelet drugs within 5 days before off-pump coronary artery bypass grafting can increase postoperative drainage volume and blood transfusion volume, but does not increase the risk of severe bleeding and early postoperative mortality. For patients with high risk left main coronary artery disease undergoing off-pump coronary artery bypass grafting, the actual situation of the patients should be considered comprehensively and the withdrawal time should be shortened if necessary.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R654.2

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