术前口服抗血小板药物的急性A型主动脉夹层动脉瘤的临床手术效果分析

目的：急性A型主动脉夹层(Acute type A aortic Disease, ATAAD）是心脏外科常见的需急诊处理的疾病之一，然而，临床中突然的胸痛也可能会误诊为急性冠状动脉综合征（Coronary Artery Diseases， CAD），并可能在急救过程中给与抗血小板治疗（Antiplatelet therapy，APT）。我们回顾分析了本中心急性主动脉基础患者，研究术前抗血小板治疗对其临床结局的影响。方法：回顾性分析了中国医科大学2015年至2020年收治的523例主动脉基础患者，其中有31名在术前接受过阿司匹林或氯吡格雷或两者联合使用的抗血小板治疗。在倾向评分匹配之前和之后，通过使用逻辑回归模型比较了APT和非APT患者的并发症发生率和死亡率。 匹配分析后剩余的样本在APT组中为30例，非APT组为80例。结果：经匹配后APT组患者数为30例，非APT组为80例。我们发现APT组中有10例（33%）既往接受经皮冠状动脉介入治疗（冠状动脉支架植入术）。 APT组的红细胞输入量更大，为8.4±6.05单位；血浆输入量401.67±727 ml，以及血小板输注量（14.07±8.92单位）。 APT组的心包及胸骨后引流量更多（5009.37±2131.44ml，P = 0.004）。 APT组的死亡率相对非APT组较高（26％比10％，P = 0.027）。术前APT是死亡率的独立预测因子（OR 6.808，95％CI1.554-29.828，P = 0.011）。结论：ATAAD修复前的APT与更多的输血和更高的早期死亡率有关。临床医生应根据患者的状况和外科医生的经验仔细考虑手术时机。

Outcomes of Preoperative Antiplatelet Therapy in Patients with Acute Type A Aortic Dissection

Objective: Acute type A aortic disease (ATAAD) is one of the common diseases that require emergency treatment in cardiac surgery. However, sudden chest pain in clinical practice may also be misdiagnosed as acute coronary syndrome ( CAD), and may received antiplatelet therapy (APT) during emergency treatment. We retrospectively analyzed the patients with ATAAD in our center, and analyzed the clinical outcomes on the patients with preoperative APT.Methods: A retrospective analysis of 523 patients with ATAAD admitted to China Medical University from 2015 to 2020, 31 of whom had received antiplatelet therapy with aspirin or clopidogrel or a combination of both before surgery. Before and after propensity score matching, the complication rate and mortality of APT and non-APT patients were compared by using a logistic regression model. The remaining samples after the matching analysis were 30 cases in the APT group and 80 cases in the non-APT group.Results: After matching, there were 30 patients in the APT group and 80 patients in the non-APT group. We found that 10 patients (33%) in the APT group had previously received percutaneous coronary intervention. The transfusion of red blood cell in the APT group was greater, 8.4±6.05 units; the plasma input was 401.67±727 ml, and the platelet transfusion (14.07±8.92 units). The pericardium and chest drainage in the APT group were more (5009.37±2131.44ml, P = 0.004). The mortality rate of the APT group was higher than that of the non-APT group (26% vs. 10%, P = 0.027). Preoperative APT was an independent predictor of mortality (OR 6.808, 95% CI 1.554-29.828, P = 0.011).Conclusion: Preoperative APT on ATAAD is associated with more blood transfusions and higher mortality. The physicians should carefully consider the timing of surgery based on the patient''s condition and the surgeon''s experience.