摘要
目的评估体外循环冠状动脉旁路移植术(CABG)前不同氯吡格雷和阿司匹林的暴露水平对术后出血和异体输血的影响。方法 195例择期行CABG患者,根据术前使用氯吡格雷和阿司匹林的情况均分为用药组、停药组和空白组。用药组包括术前氯吡格雷和阿司匹林停用不足7d者,停药组包括术前氯吡格雷和阿司匹林停用超过7d者,空白组包括术前未使用氯吡格雷和阿司匹林者。主要观察术后出血和输血情况,前者具体包括术后引流量、大出血发生率和二次开胸止血率,后者包括输注异体浓缩红细胞、新鲜冰冻血浆和浓缩血小板的量和率。结果用药组术后总引流量和大出血的发生率明显多于空白组(P<0.05或P<0.01)。浓缩红细胞、新鲜冰冻血浆的输注量和输注率及总输血率在用药组、停药组和空白组间均呈逐渐递减的趋势。用药组的浓缩红细胞、新鲜冰冻血浆的输注量和输注率以及总输血率均明显高于空白组(P<0.05或P<0.01),总输血率明显高于停药组(P<0.05)。三组围术期死亡率、并发症和不良事件的发生率差异无统计学意义。结论体外循环下CABG术前7d内暴露于氯吡格雷和阿司匹林的患者术后出血和异体输血明显增加。
Objective To evaluate the effect of different preoperative clopidogrel or aspirin exposure on bleeding and transfusion outcomes in patients receiving coronary artery bypass grafting （CABG） with cardiopulmonary bypass. Methods A total of 195 patients receiving elective on-pump CABG were recruited and stratified into 3 groups： group drug patients taking clopidogrel and aspirin within 7 days preoperatively, group drug-stop did not take clopidogrel and aspirin more than 7 days preoperatively, and group control never taking any anti-platelets. The primary endpoint was postoperative bleeding and transfusion volume including drainage, incidence of massive bleeding, second opening stanching, transfusions of packed red blood cells, fresh plasma and platelets. Results The amount of postoperative drainage and incidence of massive bleeding were more obvious in group drug than in group control（P〈0. 05 or P〈0.01）. An increasing trend was found between packed red blood cells, fresh plasma and total transfusion rate and usage of anti-platelets, and those indicators in group drug were higher than those in group control （P〈0.05 or P〈0.01）. The total transfusion in group drug was higher than that in group drug-stop （P 〈0. 05 ）. There was no significant difference in perioperative mobility, mortality and adverse events in three groups. Conclusion Clopidogrel and aspirin exposure within 7 days prior to surgery increase the risk of bleeding and transfusion during on-pump CABG.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2013年第6期525-528,共4页
Journal of Clinical Anesthesiology
关键词
体外循环
冠脉旁路移植术
氯吡格雷
阿司匹林
Cardiopulmonary bypass
Coronary artery bypass grafting
Clopidogrel
Aspirin
