低分子肝素桥接治疗在冠状动脉旁路移植加瓣膜手术患者中的应用

Application of low molecular weight heparin bridging therapy in patients undergoing coronary artery bypass grafting and valve surgery

目的:本研究旨在评估低分子肝素桥接治疗在冠状动脉旁路移植(CABG)加瓣膜手术患者中应用对术后出血、输血及早期预后的影响。方法:回顾性分析2015年1月1至2020年12月31日,在北京安贞医院就诊的冠状动脉旁路移植加瓣膜手术患者,共205例患者符合入排标准入选本研究。根据患者术前有没有接受低分子肝素桥接治疗,把患者分为低分子肝素组和无低分子肝素组。比较两组患者围术期引流、输血及早期预后情况。结果:两组患者24h引流量、二次开胸比例及早期预后无明显差异。与无低分子肝素组相比低分子肝素组患者输注了更多的血浆[300(0,600)vs.400(0,800)mL,P <0.05],透析治疗比例更高(0.7%vs. 8.9%P <0.05)。结论:低分子肝素桥接治疗增加了冠状动脉旁路移植加换瓣患者的围术期血浆输注,但对早期预后没有明显影响。

Objective: The impairment of platelet function may lead to massive perioperative bleeding, preoperative discontinuation of dual antiplatelet therapy and low molecular weight heparin(LMWH) bridging therapy is very common in coronary artery bypass grafting. However, there are few studies on bridging therapy in patients with coronary artery bypass grafting and valve surgery. The purpose of this study was to evaluate the effect of low molecular weight heparin bridging therapy on postoperative bleeding, blood transfusion and early prognosis in patients with bypass grafting and valve surgery.Methods: This study retrospectively analyzed the patients who underwent coronary artery bypass grafting and valve surgery in Beijing Anzhen Hospital from January 1, 2015 to December 31, 2020. A total of 205patients met the inclusion criteria. The patients were divided into low molecular weight heparin group and no low molecular weight heparin group according to whether they received low molecular weight heparin bridging treatment before operation. The perioperative drainage, blood transfusion and early prognosis were compared between the two groups.Results: There was no significant difference in 24-hour drain losses,the rates of reoperation for bleeding and early prognosis between the two groups. Compared with the group without LMWH, the patients in LMWH group received more plasma[300(0,600)vs.400(0,800)mL,P < 0.05], and the rates of dialysis treatment was higher(0.7% vs. 8.9%, P< 0.05). Conclusions: The preoperative use of Low molecular weight heparin is associated with higher rates of transfusion in patients with coronary artery bypass grafting and valve surgery, but had no significant effect on the early prognosis.