体外循环对冠状动脉旁路移植术后血小板聚集抑制率及阿司匹林抵抗的影响

Effect of cardiopulmonary bypass versus off-pump coronary artery bupass grafting on platelet inhibition rate and Aspirin resistance after coronary artery bypass grafting surgery

目的探讨体外循环(CPB)对冠状动脉旁路移植术(CABG)后早期血小板聚集抑制率(INHAA)及阿司匹林抵抗(AR)的影响。方法114例接受CABG手术的患者,按照手术方式不同分为两组:体外循环组54例和非体外循环组60例,术前7 d停用阿司匹林,按照分组常规进行手术,术后6 h起按常规剂量(100 mg/d)服用阿司匹林,分别于术前停药前(T0)、术后12 h(T1)、术后第5天(T2)、术后第10天(T3)和术后第15天(T4)5个时间点应用血栓弹力图(TEG)检测花生四烯酸诱导的血小板聚集抑制率(INHAA),计算AR发生率。结果体外循环组和非体外循环组组间INHAA总体差异无统计学意义(F=0.336,P=0.563);各时间点INHAA指标差异有统计学意义(F=95.519,P=0.000)。时间与分组存在交互效应(F=15.500,P=0.000)。两组间相同时间点比较,体外循环组T1时点INHAA明显高于非体外循环组,T2时点INHAA低于非体外循环组(P<0.05),T3、T4时点的INHAA差异均无统计学差异(P>0.05)。体外循环组不同时点总体差异有统计学意义(P<0.05),T2时点的INHAA均低于其他时点(P<0.05)。非体外循环组不同时点总体差异有统计学意义(P<0.05),T1时点INHAA低于其他时点(P<0.05)。两组术后AR发生率组间相同时间点对比显示体外循环组在T1时点低于非体外循环组(P<0.05),T2、T3、T4时点两组间AR发生率差异无统计学意义(P>0.05)。结论CABG术后早期存在血小板聚集抑制率的下降和AR现象,与非体外循环相比,体外循环下CABG术后12 h血小板聚集抑制率更高,AR发生率更低;术后第5天血小板聚集抑制率更低;术后5 d以后CPB对血小板聚集抑制率及AR发生率影响较小。

Objective To investigate the effect of cardiopulmonary bypass(CPB)on platelet inhibition rate(INHAA)and Aspirin resistance(AR)after coronary artery bypass grafting(CABG)surgery. Methods A total of 114 patients undergoing CABG surgery were divided into two groups: on-pump group(n=54)and off-pump group(n=60). Aspirin treatment(100 mg/d)was paused 7 days before surgery and continued 6 hours after surgery.INHAA was detected and calculated by using thrombelastography(TEG)at 6 hours after taking the last dose of aspirin before surgery(T0), 12 hours(T1), 5 days(T2), 10 days(T3)and 15 days(T4)after surgery respectively.The incidence of AR was calculated. Results There was no significant difference in the overall INHAA between the two groups of on vs.off-pump(F=0.336, P=0.563), while the differences of INHAA index at each time point was statistically significant between two groups of on vs.off-pump(F=95.519, P=0.000). There was an interaction effect of timing and grouping(F=15.500, P=0.000). In comparison of INHAA between the two groups of on vs.off-pump at each time point, INHAA was higher in on-pump group than in off-pump group at T1(P<0.05), while INHAAbecame lower in on-pump group than in off-pump group at T2(P<0.05), and there was no statistical difference in INHAAbetween the two groups at T3 and T4(P>0.05). In the on-pump group, the total difference of INHAA at different time points was significant(P<0.05), and the INHAA was lower at T2 than at T1, T3, T4(P<0.05). In the off-pump group, the total difference of INHAA between different time points was significant(P<0.05), and the INHAA was lower at T1than at T2, T3, T4(P<0.05). In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point, the incidence of AR was lower in on-pump group than in off-pump group at T1(P<0.05), while there were no statistical significance between two groups of on vs.off-pump at T2, T3 and T4(P>0.05). In comparison of AR incidence after CABG surgery between two groups of on vs.off-pump at each time point, the incidence of AR was lower in on-pump group than in off-pump group at T1(P<0.05), while there were no statistical significance between two groups of on vs.off-pump at T2, T3 and T4(P>0.05). Conclusions The increase of platelet inhibition rate and aspirin resistance occurs in early period after CABG surgery.The platelet inhibition rate is higher and aspirin resistance rate is lower in on-pump group than in off-pump group at 12 h after surgery, and the platelet inhibition rate is lower at 5 days after CABG surgery in on-pump group than in off-pump group.CPB has little effect on the platelet inhibition rate and on the incidence of AR after 5 days of CABG surgery.