阿司匹林剂量对非体外循环下冠状动脉旁路移植术后获得性阿司匹林抵抗的影响

目的：应用血栓弹力图（TEG）评价非体外循环下冠状动脉旁路移植（OPCAB）术后早期（14 d内）100 mg/d和200 mg/d阿司匹林治疗下血小板聚集抑制率（ INHAA）及获得性阿司匹林抵抗（ AR）的发生率，探讨增加阿司匹林剂量对术后早期获得性AR的影响。方法前瞻性连续选取行OPCAB术的患者60例，按术后服用阿司匹林剂量的不同随机分为两组：阿司匹林200 mg组、阿司匹林100 mg组，分别于停药前（Ta）、手术前（Tb）、术后应用阿司匹林治疗后6 h（T1）、第5天（T2）、第14天（T3）进行TEG血小板功能检测。结果术后T1、T2时200 mg组 INHAA显著高于100 mg 组（ P ＜0.05）， T3时两组差异不显著（ P＞0.05）。 T1时AR发生率200 mg组显著低于100 mg组（P＜0.05），T2、T3时AR发生率两组差异不显著（P＞0.05）。结论 OPCAB术后早期（14 d内）200 mg/d阿司匹林抗血小板治疗可以增加INHAA，减少获得性AR的发生率，有益于术后早期抗血小板治疗。

Effect of different doses of aspirin on acquired aspirin resistance following off-pump CABG

Objective To compare the AA-induced inhibition rate （ INHAA） of platelet and incidences of aspirin resistance of patients undergoing OPCAB surgery who are receiving two different doses of aspirin （200 mg/d vs.100 mg/d）within the early postoperative period （14 days）,explore the impact of additional dose of aspirin on aspirin resistance .Methods 60 patients underwent OPCAB surgery were randomly divided into two groups （ The 100 mg-group and the 200 mg-group） according to their aspirin dosages of postoperative antiplatelet therapy .INHAA were measured and calculated by thrombelastography （ TEG ） at different time points：Ta （ the day before aspirin was withdrew）,Tb（pre-operation）,T1（6 hours after first application of aspirin after OPCAB）,T2（the 5th day of aspirin therapy）,T3（the 14th day of aspirin therapy）.Results INHAA was significantly increased in patients in 200 mg-group than those in 100 mg-group at T1 and T2（P＆lt;0.05）,INHAA at T3 was not significantly different between the two groups （ P＆gt;0.05 ） .Incidence of AR was significantly reduced in patients in 200 mg-group than those in 100 mg-group at T1.Incidence of AR at T2 and T3 was not significantly different within the two groups （ P ＆gt;0.05 ）. Conclusion Additional dose of aspirin has positive effect on increasing INHAA , reducing the acquired aspirin resistance and improving the efficacy of antiplatelet therapy in early postoperative time （ within 14 days postoperation ） .