阿司匹林术前服用对非体外循环冠脉搭桥术的影响

Effects of preoperative aspirin therapy on coagulation and prognosis in patients undergoing off pump coronary artery bypass grafting.

目的评价术前持续服用抗血小板药物阿司匹林对非体外循环冠脉搭桥术凝血及短期预后的影响。方法选择持续服用阿司匹林至术前1d的非体外冠脉搭桥手术患者25例(阿司匹林组),与同期术前2周内未服用阿司匹林患者23例(对照组),分别于手术前后取中心静脉血测定ACT,PT,APTT,FIB及PLT,同时记录住院天数、引流天数、术后并发症发生率、死亡率、住ICU天数、二次开胸止血病例数、术后24h输血和胸腔引流量等指标。结果手术前2组凝血指标均在正常范围内,手术后显示PT,APTT延长,FIB水平降低,PLT数量减少(P<0.01),组间无显著差异(P>0.05),术后24h胸腔引流量,阿司匹林组较对照组增多和延长(P<0.01),输血、引流天数、二次开胸止血病例数、住ICU天数、住院天数、术后并发症发生率及病死率2组间无显著差异。结论术前服用阿司匹林会导致非体外循环冠脉搭桥手术患者凝血指标异常,术后出血量增多,但不增加患者术后并发症发生率及病死率,2组短期预后无显著差异。

Objective To evaluate the effects of continually preoperative anti-platelet drug aspirin therapy on coagulation and prognosis in patients undergoing off pump coronary artery bypass grafting （OPCABG）. Methods 25 patients undergoing OPCABG who stopped aspirin 1 day before the operation （aspirin group） and 23 patients who had not taken aspirin 2 weeks before OPCABG （control group） were studied. Blood sample was drawn from the central vein before and after the operation for testing activated clotting time （ACT） , PT, APTT, Fibrinogen （Fib） and Platelet count （PLT）. Results Before operation the laboratory data of two groups were all normal. After operation, ACT, PT and APTT prolonged,Fib level reduced and PLT counts decreased （P 〈 0. 01） , but there was no marked difference between the two groups （P 〉 0.05）. Time of keeping chest tube prolonged,blood transfusion and chest tube blood drainage 24h after operation increased,and were significantly more in aspirin group than in control group （P 〈 0.01）. The time of hospital stay, number of complication,death rate,time of ICU stay, and number of chest re-exploration were similar in both groups. Conclusion Aspirin therapy before operation will result in abnormal results and excessive bleeding after OPCABG,but it will not increase the number of complication and death rate.There is no significant difference in short-term prognosis between the two groups.