围术期抗血小板药物对外周动脉手术出血的影响

目的评估临床常用的抗血小板药物对择期因外周动脉疾病（PAD）进行手术治疗的患者围术期出血的影响。方法选择我院2006～2010年因PAD进行手术的患者81例,根据手术时服用抗血小板药物情况分为3组,未用药物组29例,单独服用阿司匹林组27例,服用阿司匹林联合氯吡格雷组25例,比较三组患者手术前后的活化部分凝血酶时间（APTT）、国际标准化比值（INR）、血小板（PLT）、血红蛋白（HB）、血细胞比容（HCT）、术中出血量、手术时间、术中是否输血及术后血肿发生率。结果三组手术前后APTT、INR、PLT、HCT均无明显变化（均P〉0.05）,术后HB较术前减少,但均在正常范围内。阿司匹林联合氯吡格雷组手术时间较前两组有延长,术中出血量与前两组比较显著增多,术后血肿发生率较前两组有所增加（均P〈0.05）。结论单用阿司匹林患者行择期PAD手术不必常规停用阿司匹林,应用阿司匹林联合氯吡格雷患者需权衡术中出血风险。

Effects of perioperative antiplatelet drugs on bleeding in patients undergoing peripheral arterial surgery

Objective To evaluate the effects of perioperative antiplatelet therapy on bleeding in patients undergoing peripheral arterial operation.Methods 81 patients undergoing operation for peripheral arterial disease(PAD) were enrolled in our hospital between 2006 and 2010.They were assigned to three groups according to the antiplatelet regimen.No drugs group(n = 29) were not received any antiplatelet drugs preoperatively.Aspirin group(n = 27) were received Aspirin alone.Aspirin and Clopidogrel group(n = 25) were received both Aspirin and Clopidogrel perioperatively.The preoperative and postoperative activated partial thromboplastin time(APTT),international normalized ratio(INR),platelet(PLT),hemoglobin(HB),hemocrit(HCT),blood loss,duration of operation,blood transfusion and incidence of postoperative hematoma were recorded and analyzed.Results The preoperative and postoperative APTT,INR,PLT,and HCT were not significantly different in all three groups(all P > 0.05).The postoperative HB of all 3 groups decreased,while still within the normal range.The differences of operation time,blood loss and incidence of postoperative hematoma in Aspirin and Clopidogrel group were statistically significant with other two groups(all P < 0.05).Conclusion Taking Aspirin alone is safe for patients undergoing elective peripheral artery operations.Patients with Aspirin and Clopidogrel therapy should take the risk of intraoperative bleeding and postoperative hematoma.