阿司匹林对鼻内镜手术围术期出血影响的临床观察

目的探讨阿司匹林对鼻内镜手术围术期出血的影响。方法回顾性分析2018-10—2021-03于郑州大学第一附属医院鼻科行鼻内镜手术并长期口服阿司匹林的67例患者的临床资料。根据围术期阿司匹林用药情况分为持续用药组(31例)和停药组(36例)。选取同期行鼻内镜手术未口服阿司匹林的中老年患者为对照组(30例)。记录术中出血量、血栓弹力图、术后出血情况及并发症,并对影响长期口服阿司匹林患者行鼻内镜手术的危险因素行Logistic回归分析。结果(1)3组患者中两两间的最大振幅(MA)、凝血综合指数(CI)差异均有统计学意义(P<0.05)。3组术后均有1例发生出血,行数据方差分析,3组间差异无统计学意义(P>0.05)。(2)鼻窦炎伴鼻息肉患者中,以及单纯鼻窦炎患者中,3组患者两两间的术中出血量差异均无统计学意义(P>0.05)。当显著性水平为0.05时,影响鼻内镜手术的独立危险因素为停用阿司匹林和BMI值。结论阿司匹林对鼻内镜手术围术期出血无明显影响,长期口服阿司匹林患者鼻内镜手术前可不停用阿司匹林。

Clinical observation of continuous use of aspirin during perioperative period of nasal endoscopic surgery

Objective To investigate the effect of aspirin on perioperative bleeding in endoscopic nasal surgery.Methods The clinical data of 67 patients who underwent nasal endoscopic surgery and long-term oral aspirin in the Rhinology Department of the First Affiliated Hospital of Zhengzhou University from 2018-10 to 2021-03 were retrospectively analyzed.According to the perioperative aspirin use,they were divided into a continuous medication group(31 cases)and a discontinuation group(36 cases).The middle-aged and elderly patients who underwent nasal endoscopic surgery and did not take aspirin during the same period were selected as the control group(30 cases).Intraoperative blood loss,thromboelastography,postoperative bleeding and complications were recorded,and logistic regression analysis was performed on the risk factors affecting nasal endoscopic surgery in patients with long-term oral aspirin.Results(1)There were statistically significant differences in the maximum amplitude(MA)and coagulation comprehensive index(CI)between the three groups of patients(P<0.05).There was 1 case of postoperative bleeding in the 3 groups,and there was no significant difference between the 3 groups by data variance analysis(P>0.05).(2)There was no significant difference in intraoperative blood loss between the three groups of patients with sinusitis complicated with nasal polyps and patients with simple sinusitis(P>0.05).When the significance level was 0.05,the independent risk factors affecting nasal endoscopic surgery were aspirin discontinuation and BMI value.Conclusion Aspirin has no significant effect on perioperative bleeding during endoscopic sinus surgery,and patients with long-term oral aspirin may not stop using aspirin before endoscopic sinus surgery.