Effect Of Preoperative Continued Antiplatelet Drugs Use On Heart Outcomes In Off-pump Coronary Bypass Operations

Objective: This test aimed to evaluate the effect of antip-latelet drugs use before off-pump coronary artery bypass(off-pump CABG)on heart outcomes,and feasible to provide clinical basisi for the OPCABG safety.Methods: 94 patients were included who accepted off-pump coronary bypass grafting in our cardiac surgery.Divided these patients into three groups based on the therapy of continued antiplatelet drugs before :A1(Taken aspirin alone,n=28),A2(Taken clopidogrel and aspirin daily,n=38),B(Stoping taking either oral antiplatelet drugs within 5 days before operation,n=28).After entering the operating room,patients were routinely monitored by Sp O2,ECG,HR,IBP,and BIS.Intravenous injection of midazolam 0.05mg/kg,etomidate 0.1~0.3mg/kg,vecuronium bromide 0.10mg/kg,fentany l10~20ug/kg,making BIS of 40~60 and keeping PETCO2 between 35~40mmHg,and temperature in 36.0~37.0?.Making MAP between 55~75mmHg,when blood pressure is lower than 55 mmHg,using norepinephrine booster.In order to avoid intraoperative continus pumping in coronary spasm nitroglycerin 0.3~1.0ug/kg/min.When return the Cardiac Surgery ICU,observe ECG changes,measure troponin values.Respectively recorded in patients with preoperative baseline data:age,gender,weight,preoperative hypertention,preoperative history of hypelipidemia,cerebral infarction,preoperative troponin,preoperative heart color to exceed the size of each cavity.Preoperative need to record: bypass count,operation time,the presence of myocardial infarction,intraoperative use of norepinephrine,the change of ST segment,day and day,the second day of troponin values,waking time,extubation time,number of days in the ICU,heart colour to exceed the size of the chamber.Above cases are the same group of the surgical team,the team to achieve the same anesthesia,ultrasonic data are by the same doctor ultrasonic measurement.Results:1 The baseline data of three groups of patients with preoperative,in addition to the history of hyperlpidemia,age,sex,weight,history of hypertension,diabetes,history of myocardial infarction,cerebrovascular disease and heart colour to exceed all differences in the size of the chamber of no statistical significance(P>0.05).2 Intraoperative bypass time of three groups of patients,bypass count,ST changes had no statistical significance(P>0.05).3 Whether intraoperative of three groups of patients with norepinephrine use was statistically significant(P<0.05),whether to stop using antiplatelet drugs in this respect no difference(P>0.05).4 Three groups of patients with and without postoperative arrhythmias occurred was statistically significant(P<0.05).In postoperative arrhythmias occur between two groups comparision,the condition of drug withdrawal difference was statistically significant.A1,A2 groups were lower than the occurence of posteroperative arrhythmia group B.Postoperative arrhythmia to A2 group is lower than the other two groups(P<0.05).5 Of three groups of patients after surgery,postoperative first day and the next the troponin values,ICU stay days,waking time,extubation time and heart colour to exceed the chamber size had no statistical difference(P>0.05).Conclutions: Preoperative not stop using antiplatelet drugs OPCABG can protect patients heart,and decrease the incidence of postoperative arrhythmia,is safe and feasible.