持续双重抗血小板药物治疗对起搏器植入术后囊袋血肿的影响-论文.pdf

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1、生国医药年1O月第8卷第1O期ChinaMedicine，October2013．Vo1．8，No．10·l361·．论著．持续双重抗血小板药物治疗对起搏器植入术后囊袋血肿的影响孟康张金荣林运曾哲淳方冬平郭成军戴文龙李海宴【摘要】目的研究持续双重抗血小板药物(DAP)治疗对起搏器植入术后囊袋血肿的影响。方法2010年6月至2013年1月，北京安贞医院长期服用DAP的起搏装置(EPD)植入的老年患者173例，完全随机分为2组，持续DAP治疗组(87例)，围术期持续服用DAP，阿司匹林100mg／d+氯比格雷75mg／d；低分子肝素桥接组(8

2、6例)围术期暂停服用DAP，以依诺肝素[1mg／(kg·12h)]桥接治疗。随访观察2组患者EPD植入后围术期内囊袋血肿的发生率。结果持续DAP治疗组囊袋血肿发生率为3．4％(3／87)，低分子肝素桥接组的囊袋血肿发生率为16．3％(14／87)。2组比较差异有统计学意义(=11．73，P=0．003)；手术时间、血肿形成时间在2组间差异有统计学意义(P<0．05)；Logistic回归分析提示，低分子肝素为影响囊袋血肿的独立危险因素(P=0．025)。结论围术期持续DAP治疗不增加EPD植入后囊袋血肿的风险。【关键词】双重抗血小板药物；

3、囊袋血肿；起搏装置；低分子肝素桥接【中图分类号】972【文献标识码】AEfectofdualanti-platelettherapyonpockethematomaafterelectrophysiologicaldeviceplacementMENGKang，ZHANGn—rong，LINYun，ZENGZhe—chun，FANGDong-ping，GUOCheng-jun，DAIWen—long，LIHai—yan．DepartmentofCardiovascularMedicine，Be~jingAnzhenHospital，Cap

4、italMedicalUnive~i@，BeingJODD29．ChinaCorrespondingauthor：MENGKang，Email：mengkang1970@hotmail．con【Abstract】ObjectiveToinvestigatetheincidenceofpockethematomaaftereleetrophysiologiealdevice(EPD)placementsinpatientswithdualanti-platelet(DAP)andlowmolecularweightheparin(LMWH)

5、bridging．MethodsOnehundredandseventy—threepatientswithdualantiplateletdrugreceivedthepacemakerimplantationandenrolledinthisprospectiveobservationalanalysis．Eighty—sevenpatientsreceivedcontinueDAPtherapy，86pa—tientsreplacedDAPdrugswithenoxaparinbridging．Theadenosinephospha

6、te—mediatedplateletaggregationandtheratioplateletaggregationinducedbythearaehidonicacid(AA)weretestedbeforeoperation．Theincidenceofpock—ethematomawasinvestigated．ResultsIncidenceofpockethematomaincontinuingDAPgroupwaslowertllanthatofdiscontinuedualAPtherapywith(LMWH)bridg

7、ingtherapygroup(3．4％VS16．3％，=l1．73，P=0．003)．PatientswithLMWHbridgingwere5．102foldmorelikelytodeveloppockethematomatllanDAPindividuals．AmultipleLogisticregressionanalysisrevealedthatLMWHwasanindependentriskfactorforthedevelopmentofpockethematoma(P=0．025)．ConclusionContinui

8、ngdualanti—platelettherapydoesnotincreasetheriskofpockethematomaafterantiarrhythmiedeviceplaceme