本文關鍵詞： 阿司匹林 出血 經(jīng)尿道前列腺電切術　出處：《山東大學》2014年碩士論文　論文類型：學位論文

【摘要】：研究背景 由于阿司匹林具有抑制血小板聚集的作用,被廣泛用于預防心腦血管疾病。大量證據(jù)證明阿司匹林能減少心血管死亡、心肌梗塞、不穩(wěn)定心絞痛、中風、短暫性腦缺血風險。但是,圍手術期服用阿司匹林具有增加手術出血風險的副作用。Shahar等估計大約有25%老年患者應當服用阿斯匹林,許多患者需終身服藥。作為二級預防,停止阿斯匹林心肌梗塞和死亡有3倍增長(OR3.14),對冠脈支架置入患者風險增加90倍(OR89.87),2個獨立的研究顯示停用阿斯匹林發(fā)生心血管事件的平均時間是8.5到10.7天,接近于血小板的壽命。 經(jīng)尿道前列腺電切術(transurethral resection of prostate, Turp)是常見的泌尿外科手術,出血是其主要術后并發(fā)癥。許多泌尿外科醫(yī)師考慮圍手術期服用阿司匹林,可能導致術后大量出血,因而要求所有患者圍手術期停用阿司匹林。新近的調(diào)查顯示絕大多數(shù)泌尿外科大夫認為,術前服用阿司匹林是經(jīng)尿道前列腺電切術手術絕對禁忌癥。 現(xiàn)在心血管指南警告不要停止抗血小板藥物,特別是患者有冠脈支架用抗血小板藥物做二級預防的。然而,經(jīng)尿道前列腺電切術患者的圍手術期管理實際情況變化很大�；颊叻萌A法林的情況相似。圍手術期抗凝藥或抗凝因子管理至今未達成共識。問題是圍手術期應用抗凝藥和抗血小板治療增加出血,隨后應用控制出血治療而增加了血栓的風險和發(fā)病率。 為此,本研究利用現(xiàn)有病案資料,總結了研究服用阿司匹林對經(jīng)尿道前列腺電切術出血的影響,以期為經(jīng)尿道前列腺電切術患者的圍手術期是否應停用抗凝藥提供科學依據(jù)。 研究目的 研究圍手術期口服阿司匹林對經(jīng)尿道前列腺電切術出血的影響。 材料與方法 研究對象來源于自2012年1月至2013年12月到高密市人民醫(yī)院、膠州市中心醫(yī)院、膠南市人民醫(yī)院泌尿外科接受經(jīng)尿道前列腺電切術的病人。 所有資料為病歷資料,本次研究共選取361例研究對象,根據(jù)研究對象既往圍手術期阿司匹林服用情況,分為3組。1組：阿司匹林組(圍手術期服用阿司匹林)50例,2組：停止服用組(術前10天及圍手術期停止服阿司匹林)86例,3組：未服用阿司匹林或抗凝劑組225例。 收集研究對象各項指標： 研究對象一般特征：包括年齡、職業(yè)、經(jīng)濟收入(年)、醫(yī)保類型、身高、體重。 生活嗜好：是否吸煙、開始吸煙時間、每日吸煙量、是否飲酒、開始飲酒時間、飲酒種類、每日飲酒量。 阿司匹林服用情況：是否服用阿司匹林,開始服用阿司匹林時間(年前)、阿司匹林每日服用量。 研究對象其他疾病史：肝功能是否正常、是否高血壓、血壓值、心功能、血肌酐(數(shù)值)、是否腎積水、是否糖尿病、是否慢性肺阻塞性疾病、心梗史、是否使用其他抗凝血藥物、腦血管意外史。 前列腺增生情況及相關癥狀：病程(年)、是否膀胱結石、術前是否反復血尿、術前是否尿路感染、術前是否留置尿管、前列腺體積等。 術中及術后指標：包括前列腺切除重量、手術時間、術中并發(fā)癥、術中出血量、術后出血量、停止沖洗時間等。 應用廣義線性回歸分析控制有關可能的混雜因素,探討數(shù)值變量指標的影響因素。 研究結果 1.對術中出血量影響因素的分析,單因素分析顯示術中出血量與前列腺體積、前列腺切除重量、手術時間正相關,P0.0001；與術前反復血尿負相關,P0.05。多因素分析顯示一直服藥組與其他2組相比,術中出血量并無差異。 2.對術后出血量影響因素的分析,單因素分析顯示術后出血量可能與家庭年收入負相關,p=0.0005；與前列腺體積、前列腺切除重量、手術時間、術中出血量、心功能障礙、是否留置尿管正相關,p值為＜0.0001、＜0.0001、＜0.0001、＜0.0001、＜0.0001、0.0117。多因素分析顯示未曾服藥組較一直服藥組的術后出血量減少了67.3138m1,p＜0.0001,術前停藥組較一直服藥組的術后出血量減少了73.3138m1,p＜0.0001。 3.對停止沖洗時間影響因素的分析,單因素分析結果表明,停止沖洗時間可能與家庭年收入負相關,P0.01；與前列腺體積、前列腺切除重量、手術時間、術中出血量、術后出血量、是否存在心功能障礙正相關。多因素分析顯示未曾服藥組與一直服藥組相比,停止沖洗時間并無差異；術前停藥組與一直服藥組相比,停止沖洗時間并無差異。 結論 行經(jīng)尿道前列腺電切術病人,圍手術期口服阿司匹林組與術前10天及圍手術期停止服阿司匹林、未服用阿司匹林或抗凝劑兩組相比,術中出血量和停止膀胱沖洗時間無明顯差異,圍手術期口服阿司匹林組與其它另組相比,術后出血量增多。 建議 因圍手術期口服阿司匹林組術后增加的出血量無明顯臨床意義,考慮到服用阿司匹林對于預防心血管事件的收益,本人建議,行經(jīng)尿道前列腺電切術時不用停服預防劑量阿司匹林。
[Abstract]:Research background
Because aspirin has inhibitory effect on platelet aggregation, is widely used in the prevention of cardiovascular and cerebrovascular diseases. A lot of evidence that aspirin reduces the risk of cardiovascular death, myocardial infarction, unstable angina, stroke, transient ischemic risk. However, perioperative use of aspirin can increase the side effects of.Shahar estimate the risk of surgical bleeding about 25% elderly patients should take aspirin, many patients need lifelong medication. As the two level prevention of myocardial infarction and stop aspirin 3 times growth death (OR3.14), coronary stent implantation in patients with increased risk of 90 times (OR89.87), 2 independent research shows that the average time of discontinuation of aspirin for cardiovascular events is 8.5 to 10.7 days and close to the platelet life.
Transurethral resection of the prostate (transurethral resection of prostate, Turp) is a common operation in the Department of Urology, hemorrhage was the main postoperative complications. Many perioperative Department of Urology physicians consider taking aspirin, may lead to massive bleeding after operation, it is required that the patients with perioperative aspirin withdrawal. Recent research showed that the majority of doctor in the Department of Urology that preoperative aspirin is transurethral resection of the prostate surgery contraindication.
Now the guide warned stop antiplatelet drugs for cardiovascular patients, especially with the two grade prevention of coronary stents with antiplatelet drugs. However, transurethral resection of the prostate in patients with perioperative management actual situation changed greatly. Similar patients taking warfarin. Perioperative anticoagulation or anticoagulant management has not reached a consensus. The problem is the application of perioperative anticoagulation and antiplatelet therapy increased bleeding, followed by treatment of bleeding control increased the risk of thrombosis and the incidence of the disease.
Therefore, the present study summarized the effect of aspirin on bleeding after transurethral resection of prostate, based on existing medical records, in order to provide a scientific basis for perioperative use of anticoagulants in patients undergoing transurethral resection of prostate.
research objective
To investigate the effect of perioperative oral aspirin on the bleeding of the transurethral resection of the prostate.
Materials and methods
The subjects were from January 2012 to December 2013, who received transurethral resection of the prostate in Gaomi City people's Hospital, Jiaozhou Central Hospital and Department of Urology of Jiaonan people's hospital.
All the information for the medical records, this study selected 361 cases of the research object, according to the situation of taking aspirin study included perioperative period, divided into 3 groups:.1 group and aspirin group (perioperative aspirin) in 50 cases, 2 groups: stop taking group (10 days before surgery and perioperative stop aspirin) in 86 cases, 3 groups: not taking aspirin or anticoagulants group 225 cases.
Collect the target of the research object:
The general features of the study include age, occupation, economic income (year), type of medical insurance, height and weight.
Life habits: smoking, starting time of smoking, daily smoking, drinking, starting time of drinking, type of drinking, and daily alcohol consumption.
Take aspirin: take aspirin, start taking aspirin (a year ago) and take the daily dose of aspirin.
Other disease history of the subjects: liver function, hypertension, blood pressure, heart function, serum creatinine (numerical value), hydronephrosis, diabetes mellitus, chronic obstructive pulmonary disease, history of myocardial infarction, use of other anticoagulant drugs, and cerebrovascular accident history.
Benign prostatic hyperplasia and related symptoms: duration (year), bladder stone, preoperative hematuria, preoperative urinary tract infection, preoperative indwelling catheter, prostate volume, etc.
Intraoperative and postoperative indicators include the weight of prostatectomy, operation time, intraoperative complications, intraoperative bleeding, postoperative bleeding, and time to stop flushing.
The generalized linear regression analysis is used to control the possible confounding factors and to discuss the influence factors of the index of numerical variables.
Research results
1. on the analysis of the factors that affect the amount of intraoperative bleeding, univariate analysis showed that the amount of bleeding and prostate volume, prostate gland weight, positive correlation, operation time and preoperative P0.0001; recurrent hematuria negative correlation, P0.05. regression analysis showed that the treatment group has been compared with the other 2 groups, the amount of intraoperative bleeding did not differ.
2. on the analysis of the factors that affect the amount of postoperative bleeding, univariate analysis showed that postoperative bleeding may be related to family income are negatively related to p=0.0005; resection of the prostate and prostate volume, weight, operation time, blood loss, intraoperative cardiac dysfunction, whether indwelling catheter is related to p value < 0.0001, < < 0.0001. 0.0001, < 0.0001, < 0.0001,0.0117. multivariate analysis showed that no medication group than the drug group had postoperative bleeding reduced 67.3138m1, P < 0.0001, preoperative discontinuation group than the drug group have postoperative bleeding reduced 73.3138m1, P < 0.0001.
3. to stop washing analysis of risk factors of time, the results of univariate analysis showed that the flushing time may stop and family income are negatively related to P0.01; resection of the prostate and prostate volume, weight, operation time, intraoperative bleeding, postoperative bleeding volume, the existence of heart dysfunction is related. Multivariate analysis showed no the drug group compared with the treatment group has no difference, stop the flushing time; preoperative discontinuation group and medication group has been compared, stop the flushing time no difference.
conclusion
Transurethral resection of the prostate patient, around the 10 day oral aspirin group and surgery and perioperative period before stopping aspirin, not taking aspirin or anticoagulants compared to the two groups, the amount of intraoperative bleeding and stop bladder irrigation time had no significant difference in perioperative oral aspirin group compared with other groups. Increase the amount of bleeding after operation.
proposal
There was no significant clinical significance in the increase of bleeding volume in the oral aspirin group during the perioperative period. Taking into account the benefits of aspirin to prevent cardiovascular events, I suggested that aspirin should not be stopped during transurethral resection of the prostate.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R699.8

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