再谈围术期服用阿司匹林对手术和椎管内麻醉的影响

Re-discussion about the effects of aspirin on surgery and spinal epidural anesthesia during the perioperative period

背景对患有心血管疾病（cardiovasculardisease，CVD）正在进行抗血小板治疗的患者，目前不仅无具体的、可被接受的围术期管理建议，而且对该类患者行椎管内麻醉存在争议，因接受抗血小板治疗可增加硬膜外血肿的风险。目的对阿司匹林的作用机制及其剂量、临床疗效与安全性关系进行综述。内容随着CVD患病率的不断增加，对接受阿司匹林治疗的高风险患者给予恰当的围手术期管理，是外科医师和麻醉医师共同面对的一个临床问题。为此，对需要行心血管或非心血管手术的CVD患者，必须在临床作出诸多治疗决策。趋向围术期抗凝治疗是以对血栓和出血事件的风险评估为依据的，应通过多学科协作来实现简化患者管理和最小化临床不良结局的治疗目标。

Background There are no specific, widely accepted recommendations for the perioperative management of patients with cardiovascular disease （CVD） receiving antiplatelet therapy, and performing neuraxial anesthesia in patients receiving antiplatelet therapy is controversial due to the increased risk of spinal epidural hematoma. Objective To review the mechanism of action of aspirin and the clinical literature for relationships among aspirin dosage, efficacy, and safety. Content With a high prevalence of CVD, the appropriate perioperative management of high-risk patients treated with aspirin is a common clinical problem for surgeons and anesthetists. For this reason, many treatment decisions have to be made for patients with CVD who need cardiac and non-cardiac surgery. Trend Perioperative antithrombotic management is based on risk assessment for thromboembolism and bleeding, and recommended approaches aim to simplify patient management and minimize negative clinical outcomes by muhidisciplinary teams.