2021 年第 2 期 第 16 卷

弥漫性冠状动脉病变外科术后早期应用新型抗血小板药物替格瑞洛的疗效分析

Effect of early application of new antiplatelet drugs after surgery on diffuse coronary artery disease

作者：刘长城方颖韦华宋伟吴震顾承雄

英文作者：Liu Changcheng Fang Ying Wei Hua Song Wei Wu Zhen Gu Chengxiong

单位：首都医科大学附属北京安贞医院心脏外科100029

英文单位：

关键词：弥漫性冠状动脉病变；冠状动脉内膜剥脱术；抗血小板；血小板聚集率

英文关键词：Diffusecoronaryarterydisease;Coronaryendarterectomy;Antiplatelet;Plateletaggregationrate

• 摘要：

• 目的 探讨弥漫性冠状动脉病变患者行冠状动脉旁路移植术（CABG）联合冠状动脉内膜剥脱（CE）术后早期应用新型抗血小板药物的疗效。方法 选取2016年1月至2019年6月在首都医科大学附属北京安贞医院因弥漫性冠状动脉病变接受择期CABG+CE的患者360例。应用随机数字表法将患者分为观察组和对照组，各180例。对照组术后口服阿司匹林＋氯吡格雷进行双联抗血小板治疗，观察组术后口服阿司匹林＋替格瑞洛进行双联抗血小板治疗。比较2组术前基线资料、手术参数、术后30 d预后情况和围术期血小板聚集率。结果 术前2组患者年龄、性别、体重指数和吸烟、高血压、2型糖尿病、血脂异常、陈旧脑梗死、周围血管疾病比例以及左心室射血分数比较差异均无统计学意义（均P＞0.05）。2组患者均顺利完成手术，桥血管吻合数量、重症监护病房治疗时间、机械通气时间和前降支内膜剥脱、2支及以上CE、应用主动脉内球囊反搏、总出血事件和严重消化道出血、脑出血、迟发性心包填塞、输血比例比较差异均无统计学意义（均P＞0.05）；观察组术后总引流量多于对照组［（1 470±561）ml比（1 220±483）ml］，术后30 d主要心血管不良事件发生率低于对照组［3.3%(6/180)比8.3%（15/180）］（均P＜0.05）。术前1 d 2组血小板聚集率比较差异无统计学意义（P＞0.05），术后第1天2组血小板聚集率均低于术前1 d，且术后第1、4、7天观察组血小板聚集率均低于对照组［(30±9)%比（50±15）%，(16±4)%比（34±9）%，(17±4)%比（28±6）%］（均P＜0.05）。结论 阿司匹林+替格瑞洛的双联抗血小板方案可使弥漫性冠状动脉病变患者CABG+CE术后快速达到满意的血小板抑制水平，降低术后30 d主要心血管不良事件发生风险。

• Objective To investigate the efficacy of new antiplatelet drugs on patients with diffuse coronary artery disease underwent coronary artery bypass grafting (CABG) combined with coronary endarterectomy (CE) at early postoperative period. Methods From January 2016 to June 2019, 360 patients with elective CABG+CE in Beijing Anzhen Hospital, Capital Medical University were randomly divided into observation group and control group, with 180 cases in each group. The control group was treated with aspirin+clopidogrel orally, and the observation group was treated  with aspirin+ricagrelor orally. The baseline data, surgical parameters,  prognosis after operation of 30 d and perioperative platelet aggregation rate were compared between the two groups. Results  There were no significant differences in the age, gender, body mass index, and smoking, hypertension, type 2 diabetes, dyslipidemia, old cerebral infarction and peripheral vascular disease ratios and left ventricular ejection fraction between the two groups before surgery (all P>0.05). All patients successfully received the operation, and there were no significant differences in the number of graft anastomosis, intensive care unit treatment time, mechanical ventilation time and anterior descending artery endarterectomy, and two or more branches CE, application of intra-aortic balloon pump, proportion of bleeding events, severe gastrointestinal hemorrhage, cerebral hemorrhage, delayed pericardial tamponade and blood transfusion of two groups (all P>0.05). The total drainage volume of the observation group was higher than that of the control group ［(1 470±561)ml vs (1 220±483)ml］, but the incidence of major cardiovascular adverse events in the observation group was lower than that of the control group ［3.3%(6/180) vs 8.3%(15/180)］ (both P＜0.05). There was no significant difference in the platelet aggregation rate between the two groups on the first day before operation (P>0.05). The platelet aggregation rates of the two groups on the first day after operation were lower than those on the first day before operation, the platelet aggregation rates on the 1, 4 and 7 d after operation of the observation group were lower than those of the control group ［(30±9)% vs (50 ±15)%, (16±4)% vs (34±9)%, (17±4)% vs (28±6)%］(all P＜0.05). Conclusion The administration antiplatelet of ticagrelor+aspirin can rapidly achieve satisfactory platelet inhibition level in patients with diffuse coronary artery disease after CABG+CE, and reduced the risk of major adverse cardiovascular events 30 d after surgery.