中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (23): 3703-3709.doi: 10.3969/j.issn.2095-4344.0244

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

颈椎手术围术期停服阿司匹林对心脑血管事件和下肢静脉栓塞风险及出血的影响

张丞贵1，王国栋1，孙建民1，刘 乐2   

  1. 1山东大学附属省立医院脊柱外科，山东省济南市  250013；2解放军第一四八医院骨科，山东省淄博市 255300
  • 出版日期:2018-08-18 发布日期:2018-08-18
  • 通讯作者: 孙建民，博士，主任医师，山东大学附属省立医院脊柱外科，山东省济南市 250013
  • 作者简介:张丞贵，男，1991年生，山东大学在读硕士，主要从事脊柱外科方面的研究。
  • 基金资助:

    山东省科技计划发展项目(2012GSF11815)

Effects of aspirin discontinuation on the risk of cardiovascular and cerebrovascular events and lower limb venousthrombosis and bleeding in the perioperative period of cervical surgery

Zhang Cheng-gui1, Wang Guo-dong1, Sun Jian-min1, Liu Le2   

  1. 1Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan 250013, Shandong Province, China; 2Department of Orthopedics, the 148 Hospital of Chinese PLA, Zibo 255300, Shandong Province, China
  • Online:2018-08-18 Published:2018-08-18
  • Contact: Sun Jian-min, M.D., Chief physician, Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan 250013, Shandong Province, China
  • About author:Zhang Cheng-gui, Master candidate, Department of Spine Surgery, Shandong Provincial Hospital, Shandong University, Jinan 250013, Shandong Province, China
  • Supported by:

    the Shandong Province Science and Technology Development Project, No. 2012GSF11815

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摘要：

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文题释义：
阿司匹林：是一种被广泛应用于抗血栓治疗的抗血小板药物，其作用原理是通过与环氧化酶1的活性部位发生不可逆的乙酰化，导致环氧化酶1失活，从而阻断花生四烯酸转化为血栓烷A2的途径，进而抑制血小板聚集，破坏血小板功能，现已被广泛应用于心脑血管疾病的一、二级预防治疗。
围手术期停用阿司匹林的争议：阿司匹林几十年来一直用于缺血性心脏病和脑血管疾病的预防，其疗效已得到很好的肯定。据统计，国外外科手术前服用阿司匹林的比率为15%-47%，国内外科手术前服用阿司匹林的比率相对较少，据统计为5%-12%。尽管有证据表明抗血小板治疗对于预防围手术期心脑血管事件有益，但阿司匹林可能增加围手术期出血及相关风险，通常手术前5-7 d停止使用阿司匹林治疗。但是，近年来，围手术期停用阿司匹林的传统观念逐渐引发争议。有多项报道指出术前停用阿司匹林会导致严重心脑血管并发症的发生，甚至导致死亡。也有研究证实，围手术期应用阿司匹林能够在心脑血管事件高风险的患者中降低心脑血管并发症的概率。因此，在围手术期是继续还是停止使用阿司匹林的问题仍未得到很好的解答。
 
摘要
背景：传统观念认为脊柱手术前应停用阿司匹林至少5-7 d以上来减少术中出血和术后硬膜外血肿风险的发生。但近年来有报道称术前停用阿司匹林可能会导致心脑血管并发症发生率显著增加。实际上颈椎手术术前是否需要停服阿司匹林的研究尚属空白。临床工作中围手术期是否需要停服阿司匹林在颈椎手术领域一直饱受争议。
目的：探讨颈椎手术围手术期停服阿司匹林对心脑血管事件和下肢静脉栓塞风险及出血的影响。
方法：收集山东大学附属省立医院2012年1月至2015年1月颈椎手术患者601例，按照纳入标准筛查后，将440例患者纳入研究，其中有22例患者长期服用阿司匹林。将服用阿司匹林的患者分成2组：阿司匹林停用组和继续服用组。停用组(n=10)在术前5-7 d停用阿司匹林，继续服用组(n=12)围手术期一直服用阿司匹林。在手术前不服用阿司匹林的418例患者被选为对照组。对3组患者围手术期心血管事件及下肢静脉栓塞风险进行量化分级，并根据评分标准将其划分为低危组与高危组，评估各组间发生出血事件、心脑血管事件及下肢静脉栓塞风险的差异。
结果与结论：①在440例颈椎病患者中，22例(5%)长期服用阿司匹林；②与不服用阿司匹林组患者相比，服用阿司匹林组患者高血压病、心血管疾病、脑血管疾病的患病率较高，而糖尿病的患病率3组之间没有差异；③3组患者之间术中失血量、术后引流量、手术时间、术后输血量及术后输血浆量比较差异无显著性意义；④阿司匹林停用组较继续服用组可能会有更高的脑梗死和肺栓塞发生率；⑤综合以上结果，作者认为颈椎术前继续服用阿司匹林是安全的，应继续服用阿司匹林来减少术中和术后并发症的发生。

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程
ORCID: 0000-0002-4466-068X(张丞贵)

关键词: 阿司匹林, 围手术期, 颈椎病, 心脑血管事件, 下肢静脉栓塞, 骨科植入物

Abstract:

BACKGROUND: Traditional view holds that aspirin should be discontinued at least 5 to 7 days before spinal surgery to reduce the risk of intraoperative bleeding and postoperative epidural hematoma. However, in recent years, it has been reported that aspirin discontinuation before surgery may increase the risk of serious cardiovascular or cerebrovascular complications. In fact, studies about whether to stop aspirin before cervical surgery is still blank. Therefore, there is no consensus on whether or not to discontinue aspirin before the cervical surgery.

OBJECTIVE: To explore the effects of discontinuing aspirin on the risk of cardiovascular, cerebrovascular events and lower limb venous thrombosis and bleeding in the perioperative period of cervical surgery.
METHODS: This study collected 601 patients undergoing cervical surgical procedures in the Shandong Provincial Hospital, Shandong University from January 2012 to January 2015, and finally 440 cases were included according to the inclusion criteria. Patients who were aspirin users (n=22) were divided into 2 groups depending on whether to discontinue aspirin before the cervical surgery. The aspirin discontinuation group (n=10) discontinued their aspirin use 5 to 7 days before surgery, while the aspirin continuation group (n=12) continued aspirin use in the perioperative period. Totally 418 patients who did not use aspirin before surgery were selected as the control group. The risk of cardiovascular and cerebrovascular events and lower limb venous thrombosis was quantitatively classified in the three groups and they were divided into low risk group and high risk group according to the criteria. The differences of risk of cardiovascular and cerebrovascular events and lower limb venous thrombosis were evaluated in each group. 
RESULTS AND CONCLUSION: (1) Of the 440 patients with cervical surgery, 22 patients (5%) had long-term aspirin use history. (2) The prevalence of hypertension, cardiovascular disease and cerebrovascular diseases in the aspirin group was higher than that in the control group. There was no difference in the prevalence of diabetes among the three groups. (3) There were no significant differences in the intraoperative blood loss, postoperative drainage, operation time, postoperative blood transfusion and postoperative plasma transfusion among the three groups. (4) The aspirin discontinuation group may have a higher incidence of cerebral infarction and pulmonary embolism than in the aspirin continuation group. (5) The aspirin continuation before the cervical surgery is safe in the perioperative period of cervical surgery and it is necessary to continue aspirin use to reduce the incidence of intraoperative and postoperative complications.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Aspirin, Cervical Vertebrae, Hemorrhage, Intraoperative Complications, Tissue Engineering

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