中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

术前持续应用阿司匹林对非体外循环下冠状动脉旁路移植术后住院患者影响的随机对照试验

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目的 探讨术前持续应用阿司匹林对非体外循环下冠状动脉动脉旁路移植术(off pump coronary artery bypass grafting,OPCABG)后住院患者的影响。 方法 对 2017 年 10 月至 2018 年 8 月首次在沈阳军区总医院心外科行单纯 OPCABG 治疗 119 例患者进行前瞻性随机对照临床试验。将 119 例患者随机分为术前停用阿司匹林组(停用 5 d 及以上)和术前持续应用阿司匹林组 (口服阿司匹林 100 mg/d)。随后由同一术者完成手术,同一麻醉团队配合,观察两组患者手术时间、术后 24 h 胸腔引流量、引流管拔除天数、输血情况、住院天数、心脑血管不良事件发生、二次开胸探查发生率等 结果 两组患者术前基线临床资料差异无统计学意义(P>0.05)。两组患者术后 24 h 胸腔引流量、输血情况、二次开胸探查发生率、住院天数、心脑血管不良事件发生率等差异无统计学意义(P>0.05)。两组患者术后均无心脑血管不良事件发生,无二次开胸探查发生。 结论 围术期持续应用阿司匹林没有增加 OPCABG 术后住院患者出血风险血液制品使用率及手术相关并发症。

Objective To investigate the effect of continuous application of aspirin before surgery on inpatients after off-pump coronary artery bypass grafting. Methods A prospective randomized controlled clinical trial was performed on 119 patients who underwent simple OPCABG treatment in the Department of Cardiac Surgery, Shenyang Military Region General Hospital from October 2017 to August 2018. A total of 119 patients were randomized to a preoperative aspirin discontinuation group and a preoperative continuous aspirin group (oral aspirin 100 mg/d). Subsequently, the same surgeon completed the operation, and the same anesthesia team cooperated to observe the operation time of the two groups, the chest drainage volume after 24 hours, the days of drainage tube removal, blood transfusion, hospitalization days, cardiovascular and cerebrovascular adverse events, and second thoracotomy. Results There was no significant difference in the clinical data of the preoperative baseline between the two groups (P>0.05). There were no significant differences in chest drainage, blood transfusion, secondary thoracotomy, hospitalization days, and incidence of cardiovascular and cerebrovascular adverse events between the two groups (P>0.05). There were no cardio-cerebral vascular adverse events in both groups after operation, and no secondary thoracotomy was performed. Conclusion Perioperative continuous use of aspirin does not increase the use of blood products and related complications in hospitalized patients with postoperative bleeding.

关键词: 非体外循环下冠状动脉旁路移植术; 阿司匹林; 出血

Key words: Off pump coronary artery bypass grafting; aspirin; bleeding