妇科手术患者围术期的抗栓治疗管理方案探讨

Optional antithrombotic therapy in patients during gynecological perioperative period

目的 探讨心脏疾病患者妇科手术围术期的抗栓治疗方案选择。方法 选取2015年1月至2016年12月首都医科大学附属北京安贞医院合并心脏疾病进行抗凝或抗血小板治疗，拟行妇科Ⅲ～Ⅳ级手术的患者64例作为观察组；配对同期64例非抗栓治疗的拟行同类妇科手术的患者作为对照组。观察组患者术前进行风险评估制定抗栓方案，分为继续组（24例）、停药组（15例）和桥接组（25例）。围术期监测患者手术时间、术中出血量、血红蛋白、凝血功能指标及术后不良事件。结果 观察组和对照组患者均顺利完成手术；桥接组术后发生1例出血事件、1例栓塞事件。桥接组平均术中出血量明显高于继续组、停药组、对照组［（225±40）ml比（114±31）、（128±21）、（120±21）ml］（P＜0.05）。停药组术后1 d国际标准化比值（INR）和凝血酶原时间（PT）明显低于继续组［（1.02±0.17）比（1.48±1.25）、（11.4±2.0）s比（14.6±9.0）s］（P＜0.05）；余各组间INR和PT差异无统计学意义（P＞0.05）。4组手术时间和手术前后血红蛋白水平差异无统计学意义（P＞0.05）。结论 心脏疾病抗栓治疗患者妇科手术前进行出血及血栓风险评估，采用合理的围术期抗栓治疗方案，安全性较高，可降低并发症的发生。

Objective To explore the selection of antithrombotic therapy in patients with heart diseases during gynecological perioperative period. Methods Sixty-four patients with anticoagulant or antiplatelet therapies undergoing Ⅲ-Ⅳ gynecological surgery from January 2015 to December 2016 in Beijing Anzhen Hospital, Capital Medical University were enrolled as observation group; 64 patients without antithrombotic therapy undergoing same type gynecological surgery were enrolled as control group. Patients in observation group had risk assessment and they were divided into 3 groups to have different antithrombotic therapies during perioperative period： continue group（24 cases）, withdrawal group（15 cases） and bridging group（25 cases）. Operation time, intraoperative blood loss, hemoglobin, coagulation function indexes and postoperative adverse events were analyzed. Results All patients completed operations. There were 1 case of bleeding and 1 case of embolism in bridging group. The mean intraoperative blood loss in bridging group was significantly higher than that in continue group, withdrawal group and control group[（225±40）ml vs （114±31）, （128±21）, （120±21）ml]（P〈0.05）. The international normalized ratio and prothrombin time 1 d after operation in withdrawal group were significantly lower than those in continue group[（1.02±0.17） vs （1.48±1.25）, （11.4±2.0）s vs （14.6±9.0）s]（P〈0.05）. Operation time and hemoglobin level showed no significant differences among groups（P〉0.05）. Conclusion Optional perioperative antithrombotic therapy based on preoperative risk assessment helps improve the safety of gynecological operation in patients with heart diseases.