合并糖尿病的冠状动脉旁路移植患者术后应用低剂量替格瑞洛的1年临床观察

目的 通过观察合并糖尿病的冠状动脉旁路移植(CABG)患者术后应用低剂量替格瑞洛1年的临床结果,为优化抗血小板治疗提供理论依据。方法 连续纳入2018年1月至2019年12月郑州市第七人民医院235例合并糖尿病的CABG患者,术后口服替格瑞洛60 mg 2次/d联合阿司匹林100 mg/d双联抗血小板治疗。主要研究终点为主要不良心脑血管事件(MACCE)的发生率,包括心肌梗死、脑卒中/短暂性脑缺血发作和心原性死亡;主要安全终点为严重出血,次要安全终点为次要或轻微出血。结果 平均随访时间(14.0±1.5)个月,16例(6.8%)患者发生MACCE,其中心原性死亡3例(1.3%),心肌梗死7例(3.0%),脑卒中/短暂性脑缺血发作6例(2.6%)。主要安全终点:未出现严重出血,次要出血12例(5.1%),轻微出血37例(15.7%)。22例(9.4%)出现药物相关呼吸困难,4例(1.7%)因呼吸困难导致停药。结论 合并糖尿病的CABG患者术后应用低剂量替格瑞洛联合阿司匹林双联抗血小板治疗显示出良好的安全性和耐受性。     

低剂量替格瑞洛联合阿司匹林双抗血小板治疗在冠状动脉旁路移植术后的应用

目的 通过观察冠状动脉旁路移植术（coronary artery bypass graft,CABG）后低剂量替格瑞洛联合阿司匹林双联抗血小板治疗的临床效果,为优化冠状动脉血运重建后抗血小板治疗方案提供理论依据。方法 2018年6月至2019年5月郑州市第七人民医院共198例CABG患者纳入研究,其中观察组（替格瑞洛60 mg组）97例,对照组（替格瑞洛90 mg组）101例。研究主要终点为术后1年主要心脑血管不良事件（major adverse cardiac and cerebrovascular events,MACCEs）包括全因死亡、脑血管意外、心肌梗死和靶血管再血管化的发生率。次要终点为出血、呼吸困难等不良事件的发生率。结果 两组患者术后1年MACCEs发生率比较,差异无统计学意义[13.4%(13/97)vs. 10.9%(11/101),P>0.05]。观察组患者术后1年出血事件发生率低于对照组,差异有统计学意义[13.4%(13/97)vs. 25.0%(25/101),P<0.05]。观察组患者术后呼吸困难发生率明显低于对照组,差异有统计学意义[4.12...     

替格瑞洛停药时间对非停跳冠状动脉旁路移植的风险影响

目的 观察口服替格瑞洛的需要急诊冠状动脉旁路移植的急性冠状动脉综合征患者与同期择期行冠状动脉旁路移植患者围手术期相关指标的变化,总结该类患者急诊手术围手术期风险.方法 回顾分析2016年1月至2019年12月在青岛阜外心血管病医院心外科接受非停跳冠状动脉旁路移植的急性冠状动脉综合征患者382例,其中分为急诊组(n=36...     

急诊及限期冠状动脉旁路移植术前停用氯吡格雷时间窗对术后主要出血事件的影响

目的:分析急诊和限期冠状动脉旁路移植术(CABG)前氯吡格雷停药时间对术后主要出血事件的影响,探索合理的术前氯吡格雷停药时间窗.方法:回顾性纳入2009年至2019年中国医学科学院阜外医院连续收治的急诊及限期行CABG的患者1610例;所有患者规律服用阿司匹林(单抗组,n=222)或阿司匹林和氯吡格雷(双抗组,n=13...     

冠状动脉旁路移植术同期行冠状动脉内膜剥脱术的围术期护理

目的:探讨冠状动脉旁路移植术(CABG)同期行冠状动脉内膜剥脱术(CE)的围术期护理策略。方法:2013年12月至2014年10月,CABG患者同期行CE术的共50例,术后观察指标:心理护理、血流动力学指标、抗凝监测指标等方面的围术期护理。结果:通过加强围术期护理,配合医生完成了50例患者的外科学治疗,术后存活率99.8%,共发生围术期心肌梗死2例,其中死亡1例,低氧血症1例,术后新发心房颤动11例,2例低心排出量综合征应用IABP辅助后得以好转,无短暂性脑缺血发作和脑卒中发生。结论:对于CABG术同期行内膜剥脱术治疗的患者,加强围术期护理是提高患者生存率的有效措施之一。     

冠状动脉旁路移植术患者的围术期护理

2000年2月至2005年2月,我院对162例冠状动脉粥样硬化性心脏病患者施行冠状动脉旁路移植术,取得良好效果.现将围术期护理体会报告如下.     

高龄患者非体外循环冠状动脉旁路移植围术期多因素分析

目的:分析制约高龄患者非体外循环冠状动脉旁路移植术后恢复的围术期危险因素。方法:回顾分析2013年8月至2014年4月,高龄非体外循环冠状动脉旁路移植患者53例,年龄75~86岁,均以左侧乳内动脉吻合左前降支;大隐静脉吻合其它分枝。所有患者均未使用序贯吻合。并行非体外循环冠状动脉旁路移植手术,手术在全麻下施行,所有患者均采用胸骨正中切口径路入胸,直视下获取左侧乳内动脉、大隐静脉。分析影响上述患者术后住院时间的危险因素。结果:心房颤动、胃肠功能紊乱、心血管意外、肾功能不全、再次机械辅助通气及脑血管意外为高龄患者术后主要并发症,以前二者最为常见。多因素Logistic回归分析显示女性、心功能Ⅲ-Ⅳ级、明显颈内动脉狭窄、慢性肾功不全、糖尿病及术中缩血管活性药物用量等,术前及术中因素为影响术后住院时间的独立危险因素;在术后并发症中,除肾功能不全,其余并发症为影响术后住院时间的独立危险因素。结论:术前多种合并症影响患者术后住院时间;术中过量血管活性药物应用提示心脏耐受力不佳,并影响术后住院时间。术后并发症,以心房颤动、胃肠功能紊乱最为常见且明显延长术后住院时间;再次机械辅助通气、脑血管意外、心血管意外发生率不高,但明显影响术后住院时间。     

冠状动脉旁路移植术围术期的观察和护理

近年来，随着人民生活水平的提高，冠状动脉粥样硬化性心脏病(冠心病)在我国发病率有所提高，冠状动脉旁路移植术(CABG)是缓解心绞痛的有效方法。1996—09／2004—07共完成CABG78例，术后取得满意疗效，现对其护理体会总结如下。     

急诊冠状动脉旁路移植术前应用双联抗血小板药物对围术期出血的影响

目的：分析冠状动脉造影术后或冠状动脉介入治疗术（percutaneous coronary intervention,PCI）失败后,需要急诊冠状动脉旁路移植术（coronary artery bypass graft,CABG）的患者,术前应用阿司匹林和氯吡格雷双联抗血小板治疗,对围术期的出血、输血和并发症等的影响。方法：选择急诊CABG的患者86例,其中术前应用阿司匹林和氯吡格雷双联,抗血小板药物至手术当日的患者38例（组1）,停用3d的患者48例（组2）,选择术前停用5 d以上的患者50例作为对照组（组3）。比较三组的术中、术后失血量和输血量、二次开胸情况以及术后并发症等。结果：三组患者的基线临床资料,差异无统计学意义（P〉0.05）,术后胸腔引流量组1明显高于组2和组3[（867.63±215.72）vs.（426.08±135.35）vs.（275.00±85.23）mL,P〈0.05],组2虽然高于组3,但差异无统计学意义（P〉0.05）,三组均无住院死亡、脑卒中及心肌梗死等相关并发症。结论：急诊CABG术前应用双联抗血小板药物至当日会明显增加术后失血量,术前3 d停用较停用5 d以上不会明显增加围术期出血和并发症的发生。对于高危患者在急诊CABG前应该综合考虑心血管事件和出血风险。     

老年患者冠状动脉旁路移植术及其围术期处理

随着冠状动脉旁路移植术(coronary artery bypass graft,CABG)在国内的迅速发展,老年患者的CABG将越来越多.本文报道1993年3月至2004年2月39例老年患者施行CABG及其围术期处理体会.     

拔管时间对冠状动脉旁路移植术后谵妄的影响

评价拔管时间对体外循环冠状动脉旁路移植患者术后谵妄的影响。方法：回顾性分析阜外医院外科SICU自2020年1月至2021年4月行单纯体外循环冠状动脉旁路移植术的患者信息。包括基本情况、基础疾病、术前超声EF值、术前血肌酐值,术中转机时间及阻断时间,术后呼吸机使用时间,拔管时间、ICU停留时间以及术后谵妄发生率。结果：共495例患者纳入研究,其中夜间拔管组54例,对照组441例。夜间拔管组患者年龄、转机时间、阻断时间及呼吸机使用时间均小于对照组,具有统计学差异。夜间拔管组20例发生术后谵妄（37.0%）,而对照组85例发生谵妄（20.5%）,卡方值9.082,p=0.004。多因素logistic回归分析结果夜间拔管为冠状动脉旁路移植术后谵妄的独立危险因素,OR:4.155, 95%CI:2.118 – 8.151, P=0.001。结论：夜间拔管增加冠状动脉旁路移植术后患者谵妄的发生率     

Work before and after coronary artery bypass grafting

Of 79 male Post Office employees in the UK undergoing first coronary artery bypass grafting in 1984 and 1985, 78 per cent resumed work, most within 2-6 months. By the end of the follow-up period (median 550 days) 65 per cent were working, 84 per cent of them normally. Prior to surgery 38 per cent had been able to work, 76 per cent of them normally. Return to work was more likely in younger employees and in those working until admission for surgery or who had only a short period off before surgery. A previous myocardial infarction made little difference to the likelihood of returning to work after surgery or continued working. The effect of type of work on work capability before and after surgery was also studied. All differences could not be related to physical demands of the job. Motivational and socioeconomic factors may have accounted for some differences.     

非体外循环冠状动脉搭桥术围术期并发症分析

目的 总结分析非体外循环冠状动脉搭桥术(OPCABG)围手术期的并发症.方法 2001-06～2009-05间121例患者在非体外循环下行冠状动脉搭桥术,其中A组(63例)采用先吻合桥血管近端"序贯式"冠状动脉搭桥方法,B组(58例)采用先吻合远端靶血管端的方法.结果 两组方法围术期出现各类并发症共49例次,其中A组术后并发症少于B组,全组痊愈出院118例,死亡3例,死因分别为围术期心梗1例,急性肾衰1例,胸骨-纵隔严重感染1例.结论 非体外循环冠状动脉搭桥术可发生术后心律失常等相关并发症,加强围手术期的处理,可降低并发症的发生率和病死率.     

替格瑞洛与氯吡格雷对老年患者冠状动脉旁路移植术后桥血管通畅率影响的比较研究

目的比较阿司匹林联合替格瑞洛与阿司匹林联合氯吡格雷在老年患者冠状动脉旁路移植术(CABG)后1年的桥血管通畅情况。方法选择2014年1月～2017年10月大连市中心医院心脏大血管外科经冠状动脉造影诊断为冠心病,拟接受择期CABG患者76例,排除7例,共计纳入69例,根据随机数字法分为A组(阿司匹林+氯吡格雷)37例,B组(替格瑞洛+阿司匹林)32例。随访期间患者失访4例,A组3例,B组1例,共计65例患者完成冠状动脉CT血管成像检查,A组34例,B组31例。评估2组桥血管通畅性,并随访心血管事件和出血事件等不良事件发生情况。结果 65例CT血管成像复查患者中,共计桥血管173根(胸廓内动脉63根,大隐静脉110根),其中A组92根(胸廓内动脉33根,大隐静脉59根),B组81根(胸廓内动脉30根,大隐静脉51根)。A组与B组桥血管通畅率及胸廓内动脉通畅率比较,差异无统计学意义(81.5%vs 91.4%;93.9%vs 93.3%,P0.05);A组大隐静脉通畅率明显低于B组,差异有统计学意义(74.6%vs 90.2%,P0.05)。多变量二元logistic回归分析显示,替格瑞洛+阿司匹林双联抗血小板治疗可以降低桥血管狭窄风险(OR=0.319,95%CI:0.107～0.951,P=0.040)。2组术后再发心绞痛/心肌梗死、主要出血事件和小出血事件比较,差异无统计学意义(P0.05)。结论老年CABG患者术后1年,替格瑞洛联合阿司匹林双联抗血小板治疗较氯吡格雷联合阿司匹林可能更好的降低静脉桥血管狭窄风险。     

Platelet activity before and after coronary artery bypass grafting

The normal response of the platelet can be altered either by increased pro-aggregatory stimuli or by diminished anti-aggregatory substances. Increased platelet activation occurs in the cardiovascular disease states of stable angina pectoris and acute coronary syndromes. Also, cardiac surgery involving cardiopulmonary bypass is associated with extensive contact between blood and synthetic surfaces and leads to a strong activation of platelets. Using light transmission aggregometry method, we tested platelet sensitivity to ADP and spontaneous activity in the platelet-rich plasma of patients before and after coronary artery bypass grafting (CABG). The median values of EC₅₀ for ADP were significantly lower at days 3 and 5 after surgery (0.33 and 0.37?µM, respectively) than before surgery (0.65?µM). The medians percentages of spontaneous platelet aggregation were significantly higher after than before surgery (16 and 15% at days 3 and 5 after surgery, respectively, vs. 5% before surgery). Thus, there is a significant increase of spontaneous platelet aggregation and platelet hyperreactivity to ADP in patients after CABG compared with those before surgery.     

Platelet activity before and after coronary artery bypass grafting

The normal response of the platelet can be altered either by increased pro-aggregatory stimuli or by diminished anti-aggregatory substances. Increased platelet activation occurs in the cardiovascular disease states of stable angina pectoris and acute coronary syndromes. Also, cardiac surgery involving cardiopulmonary bypass is associated with extensive contact between blood and synthetic surfaces and leads to a strong activation of platelets. Using light transmission aggregometry method, we tested platelet sensitivity to ADP and spontaneous activity in the platelet-rich plasma of patients before and after coronary artery bypass grafting (CABG). The median values of EC50 for ADP were significantly lower at days 3 and 5 after surgery (0.33 and 0.37 microM, respectively) than before surgery (0.65 microM). The medians percentages of spontaneous platelet aggregation were significantly higher after than before surgery (16 and 15% at days 3 and 5 after surgery, respectively, vs. 5% before surgery). Thus, there is a significant increase of spontaneous platelet aggregation and platelet hyperreactivity to ADP in patients after CABG compared with those before surgery.     

糖尿病对冠状动脉旁路移植术围手术期影响的临床研究

目的探讨糖尿病对冠状动脉旁路移植术(CABG)的影响.方法1512例患者接受CABG,其中糖尿病患者(DM组)328例,非糖尿病患者(NDM组)1184例.单变量统计分析两组术前危险因素和术后并发症.结果两组患者住院费用[DM组(6.11±2.4)万元;NDM组(5.63±2.2)万元;P＞0.05]、切口并发症(DM组:10.1%;NDM组8.9%;P＞0.05)、输血量[DM组(807.6±654.3)ml;NDM组(814.6±662.2)ml;P＞0.05]等方面差异无显著意义.两组患者术后严重并发病:低心排(DM组:1.5%;NDM组1.9%;P＞0.05)、心律失常(DM组:14.6%;NDM组15.2%;P＞0.05)、围术期心肌缺血(PMI)(DM组:1.2%;NDM组1.5%;P＞0.05)以及死亡率(DM组:1.52%;NDM组0.84%;P＞0.05)差异无显著意义.结论糖尿病患者经适当控制病情以后,CABG可以如同非糖尿病患者一样安全地实施.     

Renal dysfunction and long-term risk of ischemic and hemorrhagic stroke following coronary artery bypass grafting

Background

Renal dysfunction is associated with increased long-term mortality and incidence of myocardial infarction following coronary artery bypass grafting (CABG). Little is known about the relationship between renal dysfunction and long-term risk of stroke following CABG.

Methods and results

All 29 057 patients who underwent primary isolated CABG from 2000 through 2008 in Sweden, with no myocardial infarction within 14 days before surgery and no prior stroke, were included from the SWEDEHEART registry. During a mean follow-up of 4.5 years, there were 1563 (5.4%) first strokes (74% ischemic, 8% hemorrhagic, and 18% unspecified). Glomerular filtration rates (eGFR) were estimated using the Modification of Diet in Renal Disease equation. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated for stroke in relation to eGFR. Adjusted HR for all stroke in patients with eGFR 45 to 60, 30 to 45 and 15 to 30 mL/min/1.73 m² were; 1.17 (1.03 to 1.34), 1.52 (1.25 to 1.85) and 1.79 (1.20 to 2.65), respectively compared to patients with eGFR > 60 mL/min/1.73 m². Gender-specific analysis did not show any major differences between men and women. The adjusted risk of hemorrhagic stroke was somewhat higher than for ischemic stroke: HR 2.07 (1.15 to 3.73) vs. 1.55 (1.26 to 1.91), in patients with eGFR 15 to 45 mL/min/1.73 m².

Conclusions

Renal dysfunction is associated with increased long-term risk of stroke after primary isolated CABG. The impact of renal dysfunction on risk of stroke appears to be similar for both men and women.     

Effect of coronary artery bypass grafting on subsequent hospitalization

The rates of hospitalization during follow-up for a matched pair cohort of medically and surgically treated patients from the Angiography Registry of Seattle Heart Watch were compared. Medically and surgically treated patients were matched according to extent of disease, left ventricular ejection fraction, age, and 3 other survival rate-related characteristics. There was a 26% reduction in cardiovascular hospitalizations in the surgically treated patients (19%/year) compared with the medically treated patients (26%/year). This was due to a significant reduction in hospitalization rate for myocardial infarction (surgically treated patients 1.1%/year, medically treated patients 2.6%/year), and for other cardiovascular reasons (surgically treated patients 12.5%/year, medically treated patients 15.7%/year). No significant (p = 0.146) reduction occurred in hospitalization rate for chest pain not due to myocardial infarction (surgically treated patients 5.6%/year, medically treated patients 7.7%/year). When the perioperative infarctions are included for the surgical cohort, the overall myocardial infarction rate is not significantly different (p = 0.173) between the 2 treatment groups (surgically treated patients 1.9%/year, medically treated patients 2.6%/year). Acute myocardial infarction was an uncommon reason for hospitalization, accounting for only 8% (55 of 685) of all cardiovascular hospitalizations, and was not related to the number of stenotic vessels in medically treated patients.