经皮冠状动脉介入治疗术后高危患者围术期抗凝治疗与急性冠状动脉综合征发生的回顾分析

目的：分析经皮冠状动脉介入治疗(percutaneous coronary intervention，PCI)术后患者行非心脏手术围术期早期抗凝治疗与急性冠状动脉综合征（acute coronary syndrome, ACS）发生的关系。方法：回顾2009年5月至2011年5月于北京安贞医院行择期非心脏手术的患者资料，其中有135名患者于手术前1年内曾行PCI，且PCI术后坚持口服阿司匹林及氯吡格雷（波立维）。择期手术前予肝素替代治疗，术后分为未抗凝组（63例）、低分子肝素抗凝组（34例）及普通肝素抗凝组（38例），观察术后3日内ACS的发生情况及出血情况。结果：3组患者中未抗凝组有9人（14.3%）于术后3日内出现ACS，低分子肝素抗凝组及普通肝素抗凝组均无ACS患者出现（P<0.01）。3组患者的术后输入库存血量差异无统计学意义。结论：近期行PCI术的高危患者在行择期非心脏手术术后早期给予有效的抗凝治疗，可以明显降低围术期ACS的发生率，且并不增加术后出血的风险。

Retrospective assessment of anti-coagulative therapy and the incidence of acute coronary syndrome during perioperative period in high-risk patients who had suffered percutaneous coronary intervention recentely

Objective:To analyze the relationship between early anti-coagulative therapy and acute coronary syndrome(ACS) in the high-risk patients who have suffered percutaneous coronary intervention(PCI) recently during perioperative period of non-cardiac surgery.Methods: Patients who underwent scheduled non-cardiac surgery in our hospital from May 2009 to May 2011 were reviewed,of whom,135 patients had suffered PCI therapy within 1 year,insisting on the treatment by taking aspirin and clopidogrel(plaix) orally.These patients were administrated with heparin replacement treatment before scheduled surgeries.After surgeries,patients were divided into non-anticoagulative therapy group(63 cases),low molecular weight heparin(LMWH)-anticoagulative therapy group(36 cases) and unfractionated heparin(UFH)-anticoagulative therapy group(38 cases).The occurrence of ACS and hemorrhage in 3 days after operations was evaluated.Results: Of the 135 patients,9 developed ACS in 3 days in non-anticoagulative therapy group and none in other 2 groups(P<0.01).No statistical difference among the 3 groups in quantity of the blood transfusion was found.Conclusion: After scheduled non-cardiac surgeries,early and effective anticoagulative therapy administrated in the high-risk patients who have suffered PCI recently can obviously lower peri-operative incidence of acute coronary syndrome,and can be incapable of increasing risk of post-operative hemorrhage.