冠心病患者行甲状腺手术围术期使用低分子肝素桥接的安全性分析

Safety of low molecular weight heparin bridging during perioperative period of thyroid surgery in patients with coronary atherosclerotic heart disease

目的探讨冠心病(冠状动脉粥样硬化性心脏病)患者行甲状腺手术围术期使用低分子肝素桥接的安全性。方法选取2015年8月至2019年6月于首都医科大学附属北京安贞医院行甲状腺手术的66例冠心病患者作为观察组,另选取66例同期于本院接受相同术式但无冠心病、未接受抗血小板治疗的患者作为对照组,收集2组患者的临床资料进行回顾性分析。观察组围术期予低分子肝素桥接抗凝,对照组术前不予抗凝治疗。比较2组一般资料及术中、术后情况,记录患者围术期严重并发症及死亡情况。结果观察组年龄、男性比例均高于对照组,差异均有统计学意义(均P<0.05)。2组手术时间、术中出血量、术后引流量、引流管留置时间、术后住院时间比较[(151±50)min比(146±54)min、(48±30)ml比(46±34)ml、(95±40)ml比(90±51)ml、(4.1±2.4)d比(4.2±3.1)d、(7±3)d比(7±3)d],差异均无统计学意义(均P>0.05)。观察组总住院时间长于对照组[(16±3)d比(8±5)d],差异有统计学意义(t=2.843,P<0.001)。2组患者均顺利完成手术,围术期未出现严重并发症及死亡。结论需抗血小板治疗的冠心病患者行甲状腺手术围术期使用低分子肝素桥接具有一定安全性,不增加出血风险。

Objective To investigate the safety of low molecular weight heparin bridging during perioperative period of thyroid surgery in patients with coronary atherosclerotic heart disease.Methods From August 2015 to June 2019,66 patients with coronary atherosclerotic heart disease undergoing thyroid surgery in Beijing Anzhen Hospital,Capital Medical University were selected as the observation group.At the same period,66 patients who had no coronary atherosclerotic heart disease and no antiplatelet therapy undergoing the same types of thyroid surgery in the hospital were selected as the control group.The Clinical data of patients were retrospectively analyzed.The observation group was given low molecular weight heparin bridging anticoagulant therapy during perioperative period,and the control group was not given anticoagulant therapy before operation.The general data,intraoperative and postoperative conditions were compared between the two groups.The serious complications and death during perioperative period were recorded.Results The age and male rate of the observation group were higher than those of the control group(both P<0.05).There were no statistically significant differences in the operation time,intraoperative blood loss,postoperative drainage volume,drainage tube indwelling time,and postoperative length of stay[(151±50)min vs(146±54)min,(48±30)ml vs(46±34)ml,(95±40)ml vs(90±51)ml,(4.1±2.4)d vs(4.2±3.1)d,(7±3)d vs(7±3)d](all P>0.05).The total length of stay of the observation group was longer than that of the control group[(16±3)d vs(8±5)d](t=2.843,P<0.001).The operation was completed successfully in both groups,and there were no serious complication and death during perioperative period.Conclusion Low molecular weight heparin bridging has certain safety during the perioperative period of thyroid surgery in patients with coronary atherosclerotic heart disease requiring antiplatelet therapy without increasing the risk of bleeding.