双联抗血小板治疗不增加老年人OPCABG出血并发症

Dual antiplatelet therapy on elderly patients to be treated by off-pump coronary artery bypass grafting does not increase perioperative bleeding complications

目的评价术前联合应用氯吡格雷和阿司匹林抗血小板治疗对老年患者(65岁及以上)非体外循环冠状动脉旁路移植术(off pump coronary artery bypass grafting,OPCABG)围术期出血并发症的影响。方法回顾性总结分析276例年龄在65～83岁的OPCABG病人的临床资料,根据术前抗血小板治疗情况,分为联合应用阿司匹林+氯吡格雷组(AC组)216例,单纯应用阿司匹林组(A组)60例。比较两组患者术前临床基本资料,术中、术后情况;记录各组患者术中手术出血量,术后胸腔引流量、血液制品使用量。通过多元线性回归和逐步回归模型分析与手术出血量相关的因素。结果两组术前临床资料中AC组比A组年龄稍小,AC组比A组血小板计数少,AC组比A组凝血指标稍短,但血小板计数和凝血指标均在正常范围内,其他因素差异无统计学意义(P>0.05)。两组术中、术后均无严重并发症,无手术死亡。与A组相比,AC组的手术中血浆用量少(P=0.000),术中血小板用量多(P=0.013)。两组手术时间、术中移植血管数、术中失血量、红细胞用量无差异。术后情况,与A组相比,AC组引流总时间长(P=0.002),术后住院天数要短(P=0.005)。两组在术后机械通气时间、24小时红细胞用量,24小时血浆用量,24小时血小板用量,24小时引流量,总引流量,术后总血浆,术后总血小板用量,术后ICU时间方面差异无统计学意义(P>0.05)。多元线性回归以及逐步回归模型分析,抗血小板治疗类型因素对术中失血量(r=-0.044,P=0.996)无显著相关性。手术时间因素与术中出血量低度相关(r=0.262,P=0.000)。结论 65岁及以上患者OPCABG术前联合应用阿司匹林+氯吡格雷与单独应用阿司匹林治疗相比不增加手术出血量、术后引流量,术后血制品用量,不增加手术出血并发症。

Objective To assess whether the dual antiplatelet therapy with aspirin and clopidogrel affects operative bleeding complications in elderly patients (over 65 years of age) to be treated by off-pump coronary artery bypass grafting (OPCABG).Methods Retrospective analysis of related clinical data from 276 patients (65-83 years of age)receiving OPCABG was performed.The patients were divided into 2 groups according to the type of antiplatelet therapy:216 cases were given both clopidogrel and aspirin (group AC),while 60 cases were given aspirin alone (group A).Preoperative basic clinical information,intraoperative and postoperative general data were compared between the two groups,and intraoperative bleeding volume,postoperative pleural drainage volume and consumption of blood products were recorded.Using multiple linear regression model,the factors influencing intraoperative blood loss were further analyzed.Results The average age of group AC was younger than that of group A.The platelet count of group AC was less than group A,and each result of blood coagulation test in group AC was slightly shorter than that in group A.However,that of platelet count and blood coagulation test results were in normal range.Other factors had no statistical difference (P>0.05).The two groups of patients had no serious complications and operative mortality.Compared with group A,the consumption of plasma (P=0.000) during operation was less in group AC,but the platelet consumption in surgery is more (P=0.013).There was no statistical difference in the operative time,number of transplant blood vessels,intraoperative blood loss,and consumption of red blood cells between the two groups.Postoperatively,the total time of chest drainage in group AC was longer than that in group A (P=0.002),but the mean postoperative hospital stay was shorter (P=0.005).There was no statistical difference in the postoperative mechanical ventilation time,consumption of red blood cells,plasma and platelet during the first 24 h after surgery,volume of chest drainage during the first 24 h after surgery,postoperative consumption of plasma and platelet,total volume of postoperative chest drainage and postoperative ICU stay time between the two groups (P>0.05).Combined multiple linear enter regression and stepwise regression model revealed that the type of anti-platelet therapy had no significant correlation to intraoperative blood loss (r=-0.044,P=0.996).And the operative time were slightly related to intraoperative blood loss (r=0.262,P=0.000).Conclusion In patients over 65 years of age to undergo OPCABG,preoperative dual antiplatelet therapy with combined aspirin and clopidogrel does not increase intraoperative blood loss,volume of postoperative drainage and consumption of postoperative blood products,compared to aspirin therapy alone.Also,the dual antiplatelet therapy does not increase the risk of operative bleeding complications.