資源描述：
《支架術(shù)后患者非心臟手術(shù)的圍術(shù)期抗血小板治療》由會(huì)員上傳分享，免費(fèi)在線閱讀，更多相關(guān)內(nèi)容在行業(yè)資料-天天文庫。
1、支架術(shù)后患者非心臟手術(shù)的圍術(shù)期抗血小板治療呂慧秦永文[摘要]目前越來越多的患者接受冠狀動(dòng)脈造影及冠脈支架植入術(shù),冠狀動(dòng)脈支架術(shù)后雙重抗血小板治療成為冠心病支架術(shù)后防止血栓形成及再發(fā)心肌梗死的重要手段,但支架植入術(shù)后非心臟手術(shù)及侵入性操作會(huì)增加血栓形成的風(fēng)險(xiǎn),醫(yī)生不得不面臨術(shù)前停用雙重抗血小板治療避免出血及圍術(shù)期血栓形成的兩難境地。基于此,既往回顧性的研究表明停用抗血小板治療產(chǎn)生的冠脈血栓形成風(fēng)險(xiǎn)高于術(shù)中出血。因此建議終身服用阿司匹林,氯吡格雷應(yīng)持續(xù)使用直至支架完全內(nèi)皮化。在非心臟手術(shù)中可繼續(xù)服用阿司匹林,可停用氯吡格雷以過渡治療取
2、代,減少血栓及出血風(fēng)險(xiǎn)。經(jīng)皮冠狀動(dòng)脈介入；支架內(nèi)血栓；抗血小板治療；非心臟手術(shù)；圍術(shù)期10.3969/j.issn.1673-6583.2011.06.010200433上海,第二軍醫(yī)大學(xué)附屬長海醫(yī)院心血管內(nèi)科萬方數(shù)據(jù)·351·萬方數(shù)據(jù)@@[1]Lloyd-JonesD,AdamsR,CuarnethonM,etal.Heartdiseaseandstrokestatistics:2009update-areportfromtheAmericanHeartAssociationStatisticsCommitteeandStrok
3、eStatisticsSubcommittee[J].Circulation,2009,119(3):e21-e182.@@[2]NewsomeLT,WellerRS,GerancherJC,etal.Coronaryarterystents:Ⅱ.Perioperativeconsiderationsandmanagement[J].AnesthAnalg,2008,107(2):570-590.@@[3]BavryAA,BhattDL.Appropriateuseofdrug-elutingstents:balancingthe
4、reductioninrestenosiswiththeconcernoflatethrombosis[J].Lancet,2008,371(9630):2134-2143.@@[4]BavryAA,KumbhaniDJ,HeltonTJ,etal.Latethrombosisofdrug-elutingstents:Ameta-analysisofrandomizedclinicaltrials[J].AmJMed,2006,119(12):1056-1016.@@[5]EikelboomJW,MehtaSR.Double-do
5、seversusstandard-doseclopidogrelandhigh-doseversuslow-doseaspirininindividualsundergoingpercutaneouscoronaryinterventionforacutecoronarysyndromes(CURRENT-OASIS7):arandomisedfactorialtrial[J].Lancet,2010,376(9748):1233-1243.@@[6]Biondi-ZoccaiGG,LotrionteM,AgostoniP,eta
6、l.Asystematicreviewandmeta-analysisonthehazardsofdiscontinuingornotadheringtoaspirinamong50,279patientsatriskforcoronaryarterydisease[J].EurHeartJ,2006,27(22):667-674.@@[7]GrinesCL,BonowRO,CaseyDEJr,etal.Preventionofprematurediscontinuationofdualantiplatelettherapyinp
7、atientswithcoronaryarterystents:[J].Circulation,2007,115(6):813-818.@@[8]AugoustidesJG.Perioperativethromboticriskofcoronaryarterystents:possibleroleforintravenousplateletblockade[J].Anesthesiology,2007,107(3):516.@@[9]BroadL,LeeT,ConroyM,etal.Successfulmanagementofpa
8、tientswithadrug-elutingcoronarystentpresentingforelective,noncardiacsurgery[J].BrJAnaesth,2007,98(1):19-22.@@[10]SreeramGM,S
