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中华损伤与修复杂志(电子版) ›› 2022, Vol. 17 ›› Issue (02) : 135 -140. doi: 10.3877/cma.j.issn.1673-9450.2022.02.008

论著

替罗非班的输注策略对冠状动脉内膜剥脱术后出血的影响
何媛1, 杜莹1, 张俐鹏1, 陈敬1, 许斌1,†()   
  1. 1. 100029　首都医科大学附属北京安贞医院心脏外科
  • 收稿日期:2022-01-12 出版日期:2022-04-01
  • 通信作者: 许斌
  • 基金资助:
    北京市自然科学基金青年项目(7214222)

Effect of tirofiban infusion strategy on hemorrhage after coronary endarterectomy

Yuan He1, Ying Du1, Lipeng Zhang1, Jing Chen1, Bin Xu1,†()   

  1. 1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
  • Received:2022-01-12 Published:2022-04-01
  • Corresponding author: Bin Xu
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引用本文：

何媛, 杜莹, 张俐鹏, 陈敬, 许斌. 替罗非班的输注策略对冠状动脉内膜剥脱术后出血的影响[J]. 中华损伤与修复杂志(电子版), 2022, 17(02): 135-140.

Yuan He, Ying Du, Lipeng Zhang, Jing Chen, Bin Xu. Effect of tirofiban infusion strategy on hemorrhage after coronary endarterectomy[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2022, 17(02): 135-140.

目的

探讨替罗非班的输注方式对冠状动脉内膜剥脱术(CE)术后患者出血的影响。

方法

选入2020年6月至2021年5月在首都医科大学附属北京安贞医院行CE手术患者69例，根据术后患者输注替罗非班方式不同分为应用可调节静脉输液器组(45例)和应用静脉输液泵组(24例)，前者采用带有刻度(滚轮或滑轮)输液器，后者采用精密静脉输液泵进行临床治疗：比较2组患者术后替罗非班的输注速度、术后第1天出血量、术后第2天出血量、术后第3天出血量、术后第1天凝血四项检测结果、术后第1天肌钙蛋白检测结果等指标。数据比较采用独立样本t检验或秩和检验、χ2检验，采用线性回归模型分析术后出血量与凝血指标的相关性。

结果

静脉输液泵组患者术后第1、2天出血量为(472.6±233.6)mL、215.0 (152.5, 300.0) mL，均显著低于可调节静脉输液器组患者[(1 134.8±317.8) mL、480.0 (350.0, 600.0) mL]，差异均有统计学意义(t＝8.97, Z＝-5.81; P<0.05)；可调节静脉输液器组患者术后第1天活化部分凝血活酶时间(APTT)为(33.3±0.4)s，显著高于静脉输液泵组患者[(29.5±3.1)s]，差异有统计学意义(Z＝-4.66, P<0.05)；2组患者术后替罗非班输注速度、术后肌钙蛋白、凝血酶原时间、纤维蛋白原和D二聚体比较差异均无统计学意义(P>0.05)；线性回归分析显示术后第1天出血量和术后第2天出血量均与术后第1天APTT存在显著线性关系(R2＝0.77、0.49，P<0.05)。

结论

应用可调节静脉输液器输注替罗非班的CE术后患者APTT显著升高，增加患者术后出血量，而使用静脉输液泵输注替罗非班可显著提高术后安全性。

关键词: 冠心病, 冠状动脉内膜剥脱术, 替罗非班, 术后出血量, 药物输注策略
Objective

To explore the effect of tirofiban infusion mode on the hemorrhage of patients after coronary endarterectomy (CE).

Methods

Sixty-nine patients who underwent CE operation in Beijing Anzhen Hospital, Capital Medical University from June 2020 to May 2021 were included. According to the different infusion methods of tirofiban, the patients were divided into two groups: the application of adjustable intravenous infusion device group (45 cases) and the application of amedrop group (24 cases). The former used the infusion device with scale (roller or pulley), and the latter used the precision amedrop for clinical treatment. The postoperative infusion speed of tirofiban, blood loss on the first, second and third day after surgery were recorded and analyzed, the results of four coagulation tests and troponin detection on the first day after surgery, and other indicators were compared between the two groups. The data were compared by independent sample t-test, rank sum test and chi-square test, and linear regression model was used to analyze the correlation between postoperative blood loss and coagulation indicators.

Results

The blood loss on the first day and the second day after operation in the amedrop group were (472.6±233.6)mL and 215.0 (152.5, 300.0) mL respectively, which were lower than those in the adjustable intravenous infusion set group [(1 134.8±317.8)mL、480.0 (350.0, 600.0) mL], the differences were statistically significant(t=8.97, Z=-5.81; P<0.05). The activated partial thromboplastin time (APTT) on the first day after operation in the adjustable intravenous infusion set group was (33.3±0.4) s, which was higher than that in the amedrop group[ (29.5±3.1) s], the difference was statistically significant(Z=-4.66, P< 0.05). There was no significant difference in tirofiban infusion rate, postoperative troponin, prothrombin time, fibrinogen and D dimer between the two groups (P> 0.05). Linear regression analysis showed that there was a significant linear correlation between the blood loss on the first day and second day after operation and APTT on the first day after operation (R2= 0.77, 0.49; P<0.05).

Conclusion

The APTT and postoperative blood loss of CE patients after infusion of tirofiban with adjustable intravenous infusion device are significantly increased, while the infusion of tirofiban with amedrop can significantly improve perioperative safety of patients underwent CE.

Key words: Coronary artery disease, Coronary endarterectomy, Tirofiban, Postoperative blood loss, Drug infusion strategy
表1 替罗非班静脉不同输注方式的2组患者术前基线资料对比
组别 例数 平均年龄(岁，±s) 体重(kg, ±s) HDL(mmol/L, ±s) LDL(mmol/L, ±s) TG(mmol/L, ±s)
可调节静脉输液器组 45 62.5±8.6 73.4±14.1 1.1±0.3 2.3±0.8 1.5±0.6
静脉输液泵组 24 62.3±5.7 75.5±6.9 1.0±0.2 2.1±0.6 1.5±0.9
t/Z/χ2值   0.06 -0.39 0.70 0.51 -0.10
P值   0.95 0.70 0.49 0.62 0.92
组别 例数 TNI(pg/mL, ±s) APTT(s, ±s) PT(s, ±s) FBG(g/L, ±s) D二聚体(ng/mL, ±s)
可调节静脉输液器组 45 7.7±0.3 31.2±2.5 11.6±1.2 3.2±0.7 131.0±24.0
静脉输液泵组 24 6.9±0.7 29.6±3.4 11.6±0.7 2.9±0.7 93.0±58.8
t/Z/χ2值   -0.29 1.33 -0.06 1.00 -0.52
P值   0.77 0.20 0.95 0.33 0.61
组别 例数 男性占比[例(%)] 冠状动脉介入史[例(%)] 高血压病[例(%)] 糖尿病[例(%)] 心梗史[例(%)]
可调节静脉输液器组 45 39 (86.6) 9 (20.0) 23 (51.1) 27 (60.0) 9 (20.0)
静脉输液泵组 24 18 (75.0) 6 (25.0) 18 (75.0) 16 (66.7) 6 (25.0)
t/Z/χ2值   1.48 0.23 3.70 0.30 0.23
P值   0.32 0.76 0.07 0.61 0.76
表2 替罗非班静脉不同输注方式的2组患者术后药物输注速度、出血量和凝血四项等检测指标对比
组别 例数 药物输注速度(mL/h, ±s) 术后第1天出血量(mL, ±s) 术后第2天出血量(mL, IQR) 术后第3天出血量(mL, IQR)
可调节静脉输液器组 45 13.4±2.3 1 134.8±317.8 480.0 (350.0, 600.0) 100.0 (100.0, 150.0)
静脉输液泵组 24 13.6±1.3 472.6±233.6 215.0 (152.5, 300.0) 100.0 (52.5, 137.5)
t/Z值   -0.36 8.97 -5.81 -1.18
P值   0.91 <0.05 <0.05 0.24
组别 例数 TNI( pg/mL, ±s) APTT(s, ±s) PT(s, ±s) FBG(g/L, ±s) D二聚体(ng/mL, ±s)
可调节静脉输液器组 45 4.0±1.8 33.3±0.4 14.3±1.8 3.1±1.1 229.0±39.0
静脉输液泵组 24 6.9±1.4 29.5±3.1 14.0±0.9 2.9±0.9 139.0±29.1
t/Z值   -0.55 -4.66 0.45 0.29 -1.36
P值   0.58 <0.05 0.66 0.78 0.18
图1 直线回归分析术后第1天出血量与APTT的相关性
图2 直线回归分析术后第2天出血量与APTT的相关性
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