术前双联抗血小板药物治疗对非体外循环冠状动脉旁路移植术围手术期出血的影响

Impact of preoperative dual antiplatelet therapy on perioperative bleeding in patients undergoing off-pump coronary artery bypass grafting

目的 评价术前应用双联抗血小板药物治疗对非体外循环冠状动脉搭桥术围手术期出血事件的影响.方法 入选2013年12月至2014年6月在北京安贞医院首次接受非体外循环冠状动脉搭桥患者60例,分为术前应用阿司匹林和氯吡格雷双联抗血小板治疗（AC组,30例）及术前停用双联抗血小板治疗组（N组,30例）,记录两组患者术中、术后的基本情况,两组患者术后24 h胸腔引流量、术后胸腔总引流量,术中、术后输血及血液制品量及不良心血管事件.本研究通过北京安贞医院医学伦理委员会批准.结果 两组患者术前临床资料差异均无统计学意义（均P ＞0.05）;术中出血量差异无统计学意义[（637±257）比（635±196）ml,P=0.978];术后两组24 h胸腔引流量[（522±160）比（524±204） ml,P=0.961]、胸腔总引流量[（1 044±337）比（1 118±198） ml,P=0.306]差异亦无统计学意义.结论 患者术前应用阿司匹林及氯吡格雷双联抗血小板治疗不增加非体外循环冠状动脉搭桥术后胸腔引流量.

Objective To evaluate the impact of preopcrative dual antiplatelet therapy of aspirin and clopidogrel on perioperative blood loss and blood transfusion requirements.Methods A total of 60 patients underwent off-pump coronary artery bypass grafting （OPCABG） performed by the same surgeons.And they were assigned to receive dual antiplatelet therapy of aspirin and clopidogrel （group AC,n =30） and discontinue antiplatelet therapy more than 5 days before surgery （group control,n =30）.Results No significant inter-group differences existed in basic clinical characteristics （all P 〉 0.05）.hraopcrative blood loss volume was similar for two groups （637 ±257 vs 635 ± 196 ml,P =0.978）.No significant inter-group difference existed in 24 h chest drainage volume （522 ± 160 vs 524 ±204 ml,P =0.961） or total volume of chest drainage （1044 ± 337 vs 1118 ± 198 ml,P =0.306）.Conclusion Preoperative dual antiplatelet therapy of aspirin and clopidogrel does not increase the total volume of postoperative chest drainage.