围术期抗凝对老年伴高危因素冠心病患者冠状动脉旁路移植术预后的影响

Effect of Perioperative Anticoagulation on Prognosis of Elderly Patients with High-Risk Factors of Coronary Heart Disease after Coronary Artery Bypass Grafting

目的探讨围术期抗凝干预对老年伴高危因素冠心病患者冠状动脉旁路移植术(CABG)预后的影响。方法选取术前接受低分子肝素抗凝、非抗凝治疗的老年伴高危因素冠心病患者各50例,分别设为试验组与对照组,均接受CABG治疗,试验组术前低分子肝素2 000U/次、2次/d皮下注射,术前12h停用,对照组则不进行抗凝干预,观察两组手术时间、术中失血量、术后并发症及随访情况。结果两组手术时间、术中失血量、术后48h胸腔引流量比较,差异均有统计学意义(P<0.05)。试验组末次随访不良心血管事件发生率与对照组比较,差异无统计学意义(P>0.05)。结论术前应用低分子肝素抗凝增加非体外循环CABG患者术中失血量,且相比非抗凝干预,未能降低围术期心肌梗死及随访不良心血管事件发生率。

Objective To investigate the effect of perioperative anticoagulation intervention on the prognosis of elderly patients with high-risk factors of coronary heart disease after coronary artery bypass grafting（CABG）.Methods 100 cases of elderly patients with high-risk factors of coronary heart disease were selected and treated with CABG.50 cases treated with low molecular weight heparin anticoagulant before operation were divided into the observation group,and the other 50 cases treated with non-anticoagulant therapy before operation were divided into the control group.The patients in the observation group were treated with subcutaneous injection of low molecular weight heparin before operation.They were injected twice each day with 2000 Ueach time,but the treatment ended12 hours before the operation.The patients in the control group didn′t receive any anticoagulant intervention.Then the comparisons between the two groups were made in the operation time,intraoperative blood loss and follow-ups.Results There were significant differences between the two groups in the operation time,the intraoperative blood loss and the postoperative 48 hchest drainage volume（P〈0.05）,but there were no significant differences in the incidence rates of postoperative hemorrhage,atrial fibrillation and adverse cardiovascular events at the end of followups between the two groups（P〉0.05）.Conclusion The preoperative application of low molecular weight heparin anticoagulation will increase the intraoperative blood loss of patients with off-pump CABG,but it doesn′t reduce the incidence of perioperative myocardial infarction and adverse cardiovascular events during the follow-up in comparison to non-anticoagulation intervention.