心血管病抗栓治疗患者腮腺手术围术期的临床研究

Clinical study on perioperative period of parotidectomy in patients with antithrombotic therapy

目的:回顾心血管病行不同抗栓治疗方案的患者在腮腺手术围术期情况的临床研究。方法:选取2011年1月~2019年6月溧阳市人民医院口腔科行腮腺手术的抗栓治疗患者59例作为观察组;将同时间段内56例常规腮腺手术患者纳入对照组。观察组患者均进行术前检查及手术风险评估,制定下一步抗栓方案,分别为继续组(n=30)、停药组(n=18)和桥接组(n=11)。记录围术期患者手术操作时间、术中出血量、术后引流量,术前、术后1 d的国际标准比值(international normalized ratio,INR)、血红蛋白(hemoglobin,HGB)、血小板计数(platelet count,PLT)及凝血酶原时间(prothrombin time,PT)与不良事件发生情况。结果:观察组和对照组患者全部顺利完成手术,继续组中发生1例术后出血事件。术后引流量观察组高于对照组(P<0.05),但观察组内两两比较,差异无统计学意义(P>0.05)。手术时间及术中出血量4组间两两比较,差异无统计学意义(P>0.05)。停药组术后1 d的INR和PT低于继续组(P<0.05);桥接组术后第1天HGB和PT低于本组术前(P<0.05);余各组间INR和PT差异均无统计学意义(P>0.05)。PLT、HGB值4组间两两比较差异均无统计学意义(P>0.05)。结论:心血管病抗栓治疗患者腮腺手应在术前进行详细的出血及血栓风险评估,针对个体指定个性化的围术期抗栓治疗方案,可降低并发症的发生。

Objective:To discuss on diagnostic and treatment scheme during perioperative period of parotidectomy for patients with antithrombotic therapy.Methods:Fifty-nine parotidectomy patients with antithrombotic therapy were selected as observation group,during January 2011 and June 2019 in department of stomatology,Liyang people’s hospital.In contrast,the control group was formed by 56 parotidectomy patients without antithrombotic therapy,during the same period.Patients in the observation group were evaluated for preoperative risk and developed antithrombotic plans,then divided into continuation group(n=30),discontinuation group(n=18)and bridging group(n=11).Perioperative operation time,intraoperative bleeding volume,postoperative drainage volume,international normalized ratio(INR),hemoglobin(HGB),platelet count(PLT),prothrombin time(PT)and adverse events were recorded.Results:Both of the observation group and the control group completed the operation successfully,and one case of postoperative bleeding occurred in the continuing group.The postoperative drainage of observation group was higher than the control group(P<0.05).However,the difference was not statistically significant(P>0.05)when making pairwise comparison in observation group.Based on pairwise comparison of four groups in operative time and intraoperative blood loss,the difference was not statistically significant(P>0.05).INR and PT in the discontinuation group were lower than those in the continuing group after surgery(P<0.05).The HGB and PT after surgery on day 1 were lower than before(P<0.05).There was no statistically significant difference in INR and PT between the remaining groups(all P>0.05).When making pairwise comparison of four groups in PLT and HGB,the difference was not statistically significant(all P>0.05).Conclusion:Bleeding and thrombosis risk should be evaluated before parotidectomy surgery in patients with antithrombotic therapy.Using reasonable personal treatment scheme,the safety improved significantly,and meanwhile,the occurrence of complications reduced sharply.