摘要
目的:分析经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者行非心脏手术围术期早期抗凝治疗与急性冠状动脉综合征(acute coronary syndrome,ACS)发生的关系。方法:回顾2009年5月至2011年5月于北京安贞医院行择期非心脏手术的患者资料,其中有135名患者于手术前1年内曾行PCI,且PCI术后坚持口服阿司匹林及氯吡格雷(波立维)。择期手术前予肝素替代治疗,术后分为未抗凝组(63例)、低分子肝素抗凝组(34例)及普通肝素抗凝组(38例),观察术后3日内ACS的发生情况及出血情况。结果:3组患者中未抗凝组有9人(14.3%)于术后3日内出现ACS,低分子肝素抗凝组及普通肝素抗凝组均无ACS患者出现(P<0.01)。3组患者的术后输入库存血量差异无统计学意义。结论:近期行PCI术的高危患者在行择期非心脏手术术后早期给予有效的抗凝治疗,可以明显降低围术期ACS的发生率,且并不增加术后出血的风险。
Objective：To analyze the relationship between early anti-coagulative therapy and acute coronary syndrome（ACS） in the high-risk patients who have suffered percutaneous coronary intervention（PCI） recently during perioperative period of non-cardiac surgery.Methods： Patients who underwent scheduled non-cardiac surgery in our hospital from May 2009 to May 2011 were reviewed,of whom,135 patients had suffered PCI therapy within 1 year,insisting on the treatment by taking aspirin and clopidogrel（plaix） orally.These patients were administrated with heparin replacement treatment before scheduled surgeries.After surgeries,patients were divided into non-anticoagulative therapy group（63 cases）,low molecular weight heparin（LMWH）-anticoagulative therapy group（36 cases） and unfractionated heparin（UFH）-anticoagulative therapy group（38 cases）.The occurrence of ACS and hemorrhage in 3 days after operations was evaluated.Results： Of the 135 patients,9 developed ACS in 3 days in non-anticoagulative therapy group and none in other 2 groups（P0.01）.No statistical difference among the 3 groups in quantity of the blood transfusion was found.Conclusion： After scheduled non-cardiac surgeries,early and effective anticoagulative therapy administrated in the high-risk patients who have suffered PCI recently can obviously lower peri-operative incidence of acute coronary syndrome,and can be incapable of increasing risk of post-operative hemorrhage.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2012年第5期780-782,共3页
Journal of Peking University:Health Sciences
关键词
血管成形术
经腔
经皮冠状动脉
抗凝药
围手术期
急性冠状动脉综合征
Angioplasty
transluminal
percutaneous coronary
Anticoagulants
Perioperative period
Acute coronary syndrome
