冠状动脉旁路移植术后患者血小板高反应性的影响因素分析

目的 研究冠状动脉旁路移植术（CABG）后患者出现血小板高反应性（HTPR）的相关影响因素，旨在为术后用药提供参考。方法 选取2017年1月至2020年6月河南科技大学第一附属医院成功完成 CABG，术后使用氯吡格雷、阿司匹林治疗的 144例患者作为研究对象，其中男 110例，女 34例，年龄（55.85±7.18）岁，收集所有患者临床资料，按血小板聚集抑制率分为正常血小板反应性（NTPR）组116例、HTPR组28例。计量资料组间比较采用独立样本t检验，计数资料组间采用χ2检验或 Fisher确切概率法，单因素、多因素分析筛选患者 HTPR 的可能危险因素。结果 两组CABG患者年龄比较，差异有统计学意义（χ2=19.153，P<0.001）。HTPR组术前血肌酐指标为（74.52±9.84）μmol/L，低于 NTPR 组（83.68±13.47）μmol/L，差异有统计学意义（P<0.05）。两组 CABG 患者手术时间、24 h引流量比较，差异均有统计学意义（χ2=8.329、12.758，P<0.05）。HTPR组血块动力（K）、血块强度（MAADP）分别为（1.50±0.37）min、（49.84±6.28）mm，均高于NTPR组（1.21±0.24）min、（37.54±5.41）mm，血块动力（Alpha）、血块强度（MAthrombin）、凝血综合指数（CI）、花生四烯酸（AA）抑制率分别为（69.47±2.41）°、（64.24±2.51）mm、（1.85±0.54）、（63.28±18.63）%，均低于 NTPR 组（72.85±2.31）°、（66.86±2.74）mm、（2.97±0.92）、（79.74±16.59）%，差异均有统计学意义（均P<0.05）。多因素分析发现，年龄、性别、AA抑制率、血肌酐为 HTPR 的危险因素（均 P<0.05）。结论 年龄、性别、AA 抑制率、血肌酐为 CABG 术后患者出现HTPR的危险因素，需进行相应预防，以期减少患者HTPR发生风险。

Influencing factors of high on-treatment platelet reactivity after coronary artery bypassgrafting

Objective To study the related influencing factors of high on-treatmentplatelet reactivity (HTPR) in patients after coronary artery bypass grafting (CABG) in order toprovide references for postoperative drug application. Methods A total of 144 patients whosuccessfully completed CABG and were treated with clopidogrel and aspirin after surgery in TheFirst Affiliated Hospital of Henan University of Science and Technology from January 2017 to June2020 were selected as the research subjects, including 110 males and 34 females, aged (55.85±7.18) years. The clinical data of all patients were collected. According to the inhibition rate of plateletaggregation, they were divided into a normal on-treatment platelet reactivity (NTPR) group (116patients) and a HTPR group (28 patients). Independent sample t test was used for comparison of themeasurement data between groups, χ2 test or Fisher's exact probability method was used forcomparison of the count data between groups, and univariate and multivariate analysis were used toscreen the possible risk factors of HTPR in patients. Results The age of patients undergoing CABGwas significantly different between the two groups (χ2=19.153, P<0.001). The preoperative serumcreatinine level in the HTPR group was (74.52±9.84) μmol/L, which was lower than that in the NTPRgroup [(83.68±13.47) μmol/L], with a statistically significant difference (P<0.05). There werestatistically significant differences in the operation time and 24 h drainage volume between the twogroups (χ2=8.329, 12.758, both P<0.05). The blood clot motility (K) and blood clot intensity (MAADP)of the HTPR group were (1.50±0.37) min and (49.84±6.28) mm, respectively, which were higherthan those of the NTPR group [(1.21±0.24) min and (37.54±5.41) mm]; the blood clot dynamics(Alpha), blood clot intensity (MAthrombin), coagulation composite index (CI), and the inhibition rate ofarachidonic acid (AA) were (69.47±2.41)° , (64.24±2.51) mm, (1.85±0.54), and (63.28±18.63)% ,respectively, which were lower than those of the NTPR group [(72.85±2.31)° , (66.86±2.74) mm,(2.97±0.92), and (79.74±16.59)%], with statistically significant differences (all P<0.05). Multivariateanalysis showed that age, gender, AA inhibition rate, and serum creatinine were risk factors forHTPR (all P<0.05). Conclusion Age, gender, AA inhibition rate, and serum creatinine are riskfactors for HTPR in patients after CABG, and corresponding prevention should be carried out toreduce the risk of HTPR in patients.