抗血小板治疗对冠脉搭桥术后桥血管远期通畅率的影响

The Effect of anti-Platelet Therapy on the long-term Patency rate of the Grafts After Coronary Artery Bypass Grafting

目的观察不同抗血小板治疗方案对冠脉搭桥术后桥血管远期通畅率的影响。方法选取2013年7月-2013年12月于我院接受冠脉搭桥术的120例患者作为研究对象,按随机数字表法分为A、B、C三组,每组40例。三组均于冠脉搭桥术后24 h给予抗血小板治疗。A组单用阿司匹林方案,B组单用氯吡格雷,C组联用阿司匹林与氯吡格雷,三组均实施为期2年的随访调查,统计其术后3个月、1年及2年桥血管通畅率。结果 1术后3个月,A、B、C三组动脉桥血管通畅率分别为95.00%、97.50%、97.50%;术后1年,三组动脉动脉桥血管通畅率分别为92.50%、95.00%、95.00%;术后2年,三组通畅率分别为90.00%、90.00%、92.50%,不同随访时间点对比差异均无统计学意义(P>0.05);2术后3个月,A、B、C三组静脉桥血管通畅率分别为95.77%、95.71%、97.26%;术后1年,三组静脉桥血管通畅率分别为91.55%、94.29%、94.52%;术后2年,三组通畅率分别为85.92%、90.00%、91.78%,对比差异均无统计学意义(P>0.05)。结论单用阿司匹林、氯吡格雷或联用对冠脉搭桥术后动脉桥血管远期通畅率无显著影响,但联用阿司匹林、氯吡格雷抗血小板治疗,患者远期静脉桥血管通畅率变化趋势优于单用组。建议在冠脉搭桥术后患者可耐受的前提下联用阿司匹林、氯吡格雷方案。

Objective To observe the effect of different anti-platelet therapies on the long-term patency rate of the grafts after coronary artery bypass grafting. Methods 120 patients who received coronary artery bypass grafting in our hospital during July 2013 to December 2013 were taken as the research objects. According to the random number table method,the patients were randomly divided into A,B,C of three groups with 40 cases in each group. The three groups were treated with anti-platelet therapy in 24 h after coronary artery bypass grafting. Group A was treated with aspirin alone. Group B was treated with clopidogrel alone and group C was treated with combination of aspirin and clopidogrel. The three groups were followed up for 2years. The patency rates in 3 months,1 year and 2 year after operation were statistically analyzed. Results 13 months after operation,the patency rates of the grafts in group A,B and C were 95. 00%,97. 50% and97. 50%,respectively. 1 year after operation,the rates of the three groups were 92. 50%,95. 00% and95. 00%,respectively. 2 years after operation,the rates were 90. 00%,90. 00% and 92. 50%,respectively. The differences of different follow-up temporal points were not statistically significant（ P〉0. 05）; 2 3months after operation,the patency rates of the grafts in group A,B and C were 95. 77%,95. 71% and97. 26%,respectively. 1 year after operation,the rates of the three groups were 91. 55%,94. 29% and94. 52%,respectively. 2 years after operation,the rates were 85. 92%,90. 00% and 91. 78%,respectively. The differences were not statistically significant（ P〈0. 05）. Conclusion Aspirin alone,clopidogrel alone or the combination of the two has no significant effect on the long-term patency rate of arterial grafts,but with the combination of aspirin and clopidogrel antiplatelet therapy,the change tendency of long-term patency rate of grafts is better than that in the single use group. It is recommended adopt combination of aspirin and clopidogrel regimen within the tolerance of patients after coronary artery bypass grafting.