本文選題：阿司匹林　切入點：神經(jīng)外科　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:阿司匹林作為血小板聚集抑制劑,目前已廣泛用于預防中老年人的心腦血管疾病。然而,近來研究顯示,阿司匹林具有導致出血的潛在風險,能增加自發(fā)性顱內(nèi)出血危險性,是出血后近期死亡的獨立預測指標,那么,術前長期服用阿司匹林可能增加顱腦手術術后顱內(nèi)出血的風險。本研究的目的是:探討術前長期服用阿司匹林對中老年患者顱腦外科擇期手術術后顱內(nèi)出血等的影響,為改進臨床工作提供參考。方法:收集吉林大學第一醫(yī)院神經(jīng)腫瘤外科2016年1月至2016年9月583例患者,對患者病史、影像學資料、手術記錄、術后病程進行回顧性分析。按照納入標準,最后171例患者作為研究對象。將未服用阿司匹林的患者列為對照組,長期服用阿司匹林的患者列為實驗組。主要對長期口服阿司匹林藥物史、術前凝血常規(guī)及血小板凝集功能檢查、術后CT檢測是否出血及出血量、死亡率及出院時日常生活活動能力(ADL)分級、住院天數(shù)及術前、術后3天血紅蛋白含量等進行分析。實驗組在復查血小板凝集功能正常后實施手術。最后收集兩組患者術后出血、術后血紅蛋白含量、死亡率、出院時日常生活活動能力(ADL)分級、住院天數(shù)、術前及術后3天血紅蛋白含量情況,并采用SPSS 22.0進行統(tǒng)計學分析。結果:對照組(術前未服用阿司匹林)共143例,男性患者55例(32.2%),平均年齡為(56.4?6.7)歲,女性患者88例(51.2%),平均年齡(55.7?6.2)歲。實驗組(術前服用阿司匹林超過1個月)共28例,男性患者12例(7.0%),平均年齡為(61.8?6.5)歲,女性患者16例(9.4%),平均年齡為(60.6?5.4)歲。研究結果表明,兩組患者術后出血率無統(tǒng)計學意義(T=-0.160,P=0.8730.05)。兩組患者出院時ADL評分無統(tǒng)計學意義(Z=-1.934,P=0.0530.05)。兩組患者的死亡率均為0%。兩組患者術前與術后3天血紅蛋白含量差值具有統(tǒng)計學意義(T=-3.499,P=0.010.05),表明術前長期服用阿司匹林的患者術后有隱性失血。術前長期服用阿司匹林的患者住院天數(shù)明顯長于未服用阿司匹林的患者(T=-1.981,P=0.490.05)。結論:1.術前長期服用阿司匹林的神經(jīng)外科擇期手術的患者,待其血小板凝集功能恢復正常后進行手術,手術出血率及出院時ADL評分與未服用阿司匹林的患者無統(tǒng)計學意義。2,術前長期服用阿司匹林的神經(jīng)外科擇期手術的患者,待其血小板凝集功能恢復正常后實施手術,隱性失血及住院天數(shù)均比未服用阿司匹林的患者增多。
[Abstract]:Objective: aspirin, as an inhibitor of platelet aggregation, has been widely used to prevent cardiovascular and cerebrovascular diseases in middle-aged and elderly people. However, recent studies have shown that aspirin has the potential to cause bleeding. It can increase the risk of spontaneous intracranial hemorrhage and is an independent predictor of short-term mortality after hemorrhage. The aim of this study was to investigate the effect of long-term aspirin on intracranial hemorrhage after selective craniocerebral surgery in middle-aged and elderly patients before and after craniocerebral surgery. Methods: from January 2016 to September 2016, we collected 583 patients from the Department of Neurooncology, the first Hospital of Jilin University. The course of the disease was analyzed retrospectively. According to the inclusion criteria, 171 patients were included in the study. The patients who did not take aspirin were included as the control group. The patients who took aspirin for a long time were included in the experimental group. The patients were given long-term oral aspirin drug history, blood coagulation routine before operation and platelet agglutination function examination, and CT examination after operation was used to detect bleeding and bleeding volume. The mortality and ADL grade, the days of hospitalization and the hemoglobin content before operation and 3 days after operation were analyzed. The patients in the experimental group were operated on after checking the platelet agglutination function. Finally, the patients in the two groups received postoperative bleeding. Hemoglobin content, mortality rate, ADL grade at discharge, hospitalization days, hemoglobin content before and 3 days after operation, SPSS 22.0 was used for statistical analysis. Results: there were 143 cases in control group (without aspirin before operation) and 55 cases in male patients (mean age was 56.4? 6. 7 years old, 88 cases of female patients with 51.2%, mean age of 55.7? 6. 2 years old. There were 28 patients in the experimental group (taking aspirin for more than 1 month before operation) and 12 male patients (mean age was 61.8? 6.5 years old, 16 female patients with an average age of 60.6? 5.4 years of age. The results of the study show that. There was no significant difference in postoperative bleeding rate between the two groups. There was no significant difference in ADL score at discharge between the two groups. The mortality rate of both groups was 0. The difference of hemoglobin content between preoperative and postoperative 3 days was statistically significant. The results showed that the patients who had taken aspirin for a long time before operation had recessive blood loss after operation. The days of hospitalization of the patients who took aspirin for a long time before operation were significantly longer than that of patients without aspirin. Conclusion: 1. Patients undergoing elective neurosurgery, When the platelet agglutination function returned to normal, the bleeding rate and the ADL score at discharge had no significant difference with those of the patients without aspirin, and the patients who had taken aspirin for a long time before operation were selected for neurosurgery. When the platelet agglutination function returned to normal, the recessive blood loss and hospitalization days were more than those without aspirin.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.1

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