冠心病心脏支架术后鼻内镜手术持续不间断应用抗血小板药物对出血及再缺血事件的影响

Effect of continuous non-stop application of anticoagulant drugs on perioperative endoscopic hemorrhage and re-obstruction in patients with coronary heart disease after cardiac stenting

目的:探讨冠心病心脏支架术后鼻内镜围术期持续不间断应用抗血小板药物对术中术后出血及再缺血事件的影响。方法:冠心病支架术后每日口服100 mg阿司匹林,12个月以上患者,对照组术前7 d停止服用,术后3 d恢复;实验组则持续服用不予停药。根据病变范围行鼻内镜下鼻-鼻窦炎手术。根据Bezoart法评估术中术野出血情况并分析术后7 d内再次鼻腔出血情况及鼻内镜围术期缺血事件的发生率。结果:两组患者术中术野出血分级(Z=-1.38,P>0.05),差异无统计学意义;术后再出血事件(χ^2=3.915,P<0.05),差异有统计学意义;术后再缺血事件(χ^2=0.281,P>0.05),差异无统计学意义。结论:冠心病支架术后12个月鼻内镜围术期持续不间断应用抗血小板药物,对鼻内镜术中出血及术后再缺血均无影响,但会增加术后鼻腔再次出血事件。

Objective:To investigate the effect of continuous non-stop application of anticoagulant drugs on postoperative bleeding and re-obstruction during endoscopic surgery in patients with coronary heart disease after cardiac stenting.Methods:Patients with coronary artery disease received 100 mg of aspirin daily for more than 12 months.The control group stopped taking it 7 days before surgery and recovered 3 days after surgery.The experimental group continued to take no withdrawal.Endoscopic nasal-sinusitis surgery was performed according to the extent of the lesion.According to the Bezoart method,the intraoperative blood in the operation was evaluated and the incidence of recurrent nasal bleeding and perioperative embolization events within 7 days after surgery were counted.Results:There were no statistically significant differences in intraoperative local hemorrhage between the two groups(Z=0.00,P>0.05).There was a statistically significant difference in postoperative rebleeding events(χ^2=3.915,P<0.05).The embolization event(χ^2=0.281,P>0.05),the difference was not statistically significant.Conclusions:Continuous perfusion of anticoagulant drugs during the perioperative period of coronary heart disease stent has no statistically significant effect on endoscopic hemorrhage and postoperative embolization,but it will increase postoperative nasal rebleeding.