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目的评价围手术期不同补液速度对冠心病患者支架置入后血小板聚集率的影响。方法应用统计软件随机入选2009年1月至2009年6月连续在本研究所住院并行冠状动脉介入诊疗的冠心病患者37例,根据补液速度分为常规补液组和快速补液组。常规补液组和快速补液组的围手术期补液速度分别为1.5～2.0ml.kg-1.h-1和6～9ml.kg-1.h-1。记录患者的临床特征、围手术期病情变化、血压及心室率,检测血小板聚集率和血浆渗透压的变化。结果快速补液组共有20例患者顺利完成试验,有5例患者在围手术期发生轻微出血并发症,无严重不良事件发生。常规补液组共有17例患者完成试验,有4例患者在围手术期发生轻微出血并发症;另有3例患者因术后4h内出现胸闷、胸痛等临床症状伴低血压状态被排除本试验。所有患者在围手术期内的心室率、收缩压及血浆渗透压的变化均与补液速度关系不大。常规补液组术前的血小板聚集率与术后4h相比无明显改变(16.90%±5.15%比14.20%±5.05%,P>0.05)。快速补液组术后4h、术后次日的血小板聚集率与术前相比均有明显的降低,差异均有统计学意义(6.45%±5.85%比20.55%±4.97%,7.00%±6.78%比20.55%±4.97%,P均<0.05)。结论冠心病患者支架置入的围手术期予快速补液是安全可行的,且较常规补液相比明显降低血小板聚集率。
Objective To evaluate the effect of perioperative rehydration rate on platelet aggregation in patients with coronary heart disease after stent implantation. Methods Thirty-seven patients with coronary heart disease who were hospitalized with coronary intervention in our hospital from January 2009 to June 2009 were randomly divided into routine rehydration group and rapid rehydration group according to rehydration rate. Perioperative rehydration rates were 1.5-2.0ml.kg-1.h-1 and 6-9ml.kg-1.h-1 for the conventional fluid replacement group and the rapid rehydration group, respectively. The clinical features, perioperative changes of the disease, blood pressure and ventricular rate, platelet aggregation rate and plasma osmotic pressure were recorded. Results A total of 20 patients in the rapid rehydration group successfully completed the trial. Five patients developed minor bleeding complications during the perioperative period and no serious adverse events occurred. A total of 17 patients in the routine rehydration group completed the trial. Four patients developed minor bleeding complications during the perioperative period. Another three patients were excluded from the clinical symptoms due to chest tightness and chest pain within 4 hours after operation. All patients in the perioperative ventricular rate, systolic blood pressure and plasma osmolality changes have little to do with the infusion rate. Conventional rehydration group preoperative platelet aggregation rate and postoperative 4h compared to no significant change (16.90% ± 5.15% vs 14.20% ± 5.05%, P> 0.05). The rate of platelet aggregation at 4 h after operation and immediately after operation in rehydration group was significantly lower than that before operation (6.45% ± 5.85% vs. 20.55% ± 4.97%, 7.00% ± 6.78% More than 20.55% ± 4.97%, P <0.05). Conclusion It is safe and feasible to provide rapid rehydration during perioperative period in patients with coronary heart disease, and significantly reduce the rate of platelet aggregation compared with conventional rehydration.