本文選題：阿司匹林 + 冠心病��； 參考：《天津醫(yī)科大學》2015年碩士論文

【摘要】：目的:分析冠心病患者OPCAB術前使用阿司匹林的風險和獲益,并進一步分析阿司匹林在老年患者中的應用。方法:采用回顧性隊列研究。選取2010年1月~2014年6月天津市胸科醫(yī)院連續(xù)首次擇期OPCAB手術病例。依據術前5天內使用阿司匹林情況分為兩組,通過單因素和傾向指數回歸分析方法比較兩組患者術后住院期間預后的差異。進一步選取其中65歲以上患者,使用相同方法比較兩組老年患者預后。通過對早期預后的比較,評價OPCAB患者術前使用阿司匹林的風險和獲益。結果:總計納入患者3531例,其中男性2564例,女性967例,平均年齡63.2(±8.5)歲。持續(xù)使用阿司匹林至術前5天內817例,術前停用阿司匹林5天及以上2714例。全組患者術后院內死亡29例。通過傾向指數回歸分析,術前5天內服用阿司匹林與停藥相比,住院期間全因死亡率(校正OR0.89,95%CI0.35-2.26,P=0.80)、術后心肌梗死(校正OR0.52,95%CI0.15-1.81,P=0.31)、腦血管意外(校正OR 1.06,95%CI0.32-3.49,P=0.93)、腎衰(校正OR0.86,,95%CI0.40-1.84,P=0.70)、血液透析(校正OR0.66,95%CI0.12-2.68,P=0.48),開胸止血(校正OR0.79,95%CI0.46-1.36,P=0.40),差異無統(tǒng)計學意義,而服用阿司匹林組術后輸紅細胞比例較高(校正OR1.39,95%CI1.16-1.66,P0.01)。老年患者(65歲)中,通過傾向指數回歸分析,術前5天內服用阿司匹林與停藥相比,住院期間全因死亡率(校正OR0.53,95%CI0.15-1.95,P=0.34)、術后心肌梗死(校正OR0.32,95%CI0.04-2.62,P=0.29)、腦血管意外(校正OR 1.30,95%CI0.24-6.91,P=0.76)、腎衰(校正OR0.53,,95%CI0.17-1.65,P=0.27)、血液透析(校正OR0.42,95%CI0.05-3.38,P=0.44),開胸止血(校正OR0.57,95%CI0.41-1.87,P0.01)差異無統(tǒng)計學意義,同樣,服用阿司匹林組紅細胞輸血比例較高(校正OR1.50,95%CI1.13-2.00,P0.01)。結論:1.OPCAB術前5天內使用阿司匹林會增加紅細胞輸注,沒有增加二次開胸止血的發(fā)生率。2.OPCAB術前5天內使用阿司匹林與術后早期死亡率、早期心肌梗死、腦血管意外、腎衰和透析等發(fā)生率無相關性。3.老年(65歲)患者OPCAB術前5天內使用阿司匹林會增加紅細胞輸注,沒有增加二次開胸止血的發(fā)生率。4.老年(65歲)患者OPCAB術前5天內使用阿司匹林與術后早期死亡率、早期心肌梗死、腦血管意外、腎衰和血液透析等發(fā)生率無相關性。5.上述研究結論有待大規(guī)模隨機對照臨床試驗進一步證實。
[Abstract]:Aim: to analyze the risk and benefit of aspirin use in patients with coronary heart disease (CHD) before OPCAB, and to further analyze the use of aspirin in elderly patients. Methods: retrospective cohort study was used. From January 2010 to June 2014, we selected the first consecutive elective OPCAB operation in Tianjin chest Hospital. The patients were divided into two groups according to the use of aspirin within 5 days before operation. The prognosis of the two groups during hospitalization was compared by univariate and tendency index regression analysis. Patients over 65 years of age were further selected to compare the prognosis of the two groups with the same method. To evaluate the risk and benefit of aspirin use in patients with OPCAB before operation by comparing early prognosis. Results: a total of 3531 patients were included, including 2564 males and 967 females, with an average age of 63.2 (鹵8.5) years. There were 817 patients who continued to use aspirin for 5 days before operation and 2714 patients who stopped using aspirin for 5 days or more before operation. 29 patients died in hospital after operation. By regression analysis of propensity index, aspirin was taken within 5 days before operation compared with withdrawal. Total mortality rate during hospitalization (corrected OR0.8995 CI0.35-2.26 P0.80, postoperative myocardial infarction (corrected OR0.5295 CI 0.15-1.81 P0.31), cerebrovascular accident (OR 1.0695 CI 0.32-3.49 P0.93), renal failure (corrected OR0.8695 CI0.40-1.84P 0.70), hemodialysis (corrected OR0.6695CI0.12-2.68 Pnu 0.48), thoracotomy and hemostasis (corrected OR0.7995 CI0.46-1.36 P0.40), no statistical significance. In aspirin group, the ratio of red blood cell transfusion was higher (corrected OR 1.39 ~ 95CI 1.16-1.66C P 0.01). In elderly patients (65 years old), the tendency index regression analysis showed that aspirin intake within 5 days before operation was compared with withdrawal. Total mortality rate during hospitalization (adjusted OR0.5395 CI0.15-1.95CI0.34), postoperative myocardial infarction (corrected OR0.32m95 CI0.04-2.62P0.29, cerebrovascular accident (OR 1.3095 CI 0.24-6.91P0.76), renal failure (corrected OR0.5395CI0.17-1.65P0.27), hemodialysis (corrected OR0.4295CI5-3.38Pl 0.44), thoracotomy and hemostasis (corrected OR0.5795 CI0.41-1.87 P0.01) had no statistical significance, the same was true. The proportion of red blood cell transfusion was higher in aspirin group (corrected OR 1.50 ~ 95CI 1.13-2.00 P 0.01). Conclusion: 1. The use of aspirin within 5 days before OPCAB can increase the red blood cell infusion, but not the incidence of secondary thoracotomy and hemostasis. 2. Before OPCAB, aspirin use within 5 days before operation and early postoperative mortality, early myocardial infarction, cerebrovascular accident, and so on. There was no correlation between renal failure and dialysis. Aspirin increased erythrocyte infusion within 5 days before OPCAB, but did not increase the incidence of secondary thoracotomy hemostasis. There was no correlation between aspirin use and postoperative early mortality, early myocardial infarction, cerebrovascular accident, renal failure and hemodialysis. These conclusions need to be further confirmed in a large-scale randomized controlled clinical trial.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R654.2

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