胸外科微创手术围术期继续口服阿司匹林对老年患者出血及血栓栓塞风险的影响

Effect of continuous oral aspirin on the bleeding and thromboembolism risk after minimally invasive thoracic surgery in elderly patients

目的:探讨胸外科微创手术围术期继续口服阿司匹林对老年患者出血及血栓栓塞风险的影响。方法:回顾性分析2015年1月—2022年5月在武汉大学中南医院胸外科行胸部微创手术并长期口服阿司匹林的60例老年患者的临床资料。30例患者(实验组)手术前停用阿司匹林,使用低分子肝素抗凝替代;另外30例(对照组)术前继续口服阿司匹林,所有患者术前均行血栓弹力图(TEG)检查。比较两组患者的术中出血量、术后24 h及72 h引流量、住院时长、血栓并发症。结果:实验组和对照组两组患者在术中出血、术后24 h及72 h引流量、血栓并发症的发生率、住院时长等方面的差异无统计学意义(P>0.05)。结论:对于长期口服阿司匹林并接受胸部微创手术的老年患者,围术期继续口服阿司匹林不增加术中出血量和血栓并发症的发生率,在TEG合理监测凝血功能下,可不停用阿司匹林。

Objective:To study the effect of continuous oral aspirin on the risk of bleeding and thromboem‐bolism after minimally invasive thoracic surgery in elderly patients.Methods:A retrospective analysis was performed on 60 elderly patients who underwent minimally invasive thoracic surgery and took aspirin for a long time in Zhongnan Hospital of Wuhan University from January 2015 to May 2022.Thirty patients(experimental group)stopped taking aspirin before the operation and used low molecular weight heparin as an anticoagulant,while another thirty patients(control group)continued to take aspirin before the operation.All patients were examined by thromboelastography(TEG)before the operation.Intraoperative blood loss,postoperatively drainage at the end of 24 h and 72 h,length of hospital stays,and thrombotic complications were compared between the two groups.Results:There was no significant difference between the experimental and the control group in intraoperative bleeding,drainage volume at the end of 24 h and 72 h after operation,incidence of thrombotic complications,and length of hospitalization(P>0. 05). Conclusion: For the elderly patients who did not stop taking aspirinduring the perioperative period, the amount of bleeding and the incidence of thrombosis complicationsdid not increase during thoracic minimally invasive surgery. Aspirin may not be stopped whenTEG reasonably monitors the blood coagulation function.