CN111248954A - 肝素或阿司匹林在制备主动脉腔内修复的药物中的应用 - Google Patents
肝素或阿司匹林在制备主动脉腔内修复的药物中的应用 Download PDFInfo
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Abstract
本发明提供了肝素或阿司匹林在制备主动脉腔内修复的药物中的应用以及一种主动脉和冠状动脉疾病一站式腔内介入的手术方法。本发明具体提供了依次对病人实施主动脉腔内修复术和经皮冠状动脉介入治疗。本发明属于医学治疗领域，实施本发明具有以下优势：(1)两种疾病一站式处理，既避免了分次手术时抗血小板治疗上的矛盾，也避免了分次手术的潜在风险；(2)患者只经历一次麻醉和手术，心理更容易接受；(3)降低住院费用，缩短住院时长，降低医疗资源消耗。
Description
技术领域：
本发明属于医学治疗领域，具体提供肝素在制备主动脉腔内修复的药物中的应用；以及依次对病人实施主动脉腔内修复术和经皮冠状动脉介入治疗。
背景技术：
全身动脉粥样硬化患者广泛存在。伴随着我国人口老龄化的加剧，多发动脉粥样硬化疾病的负担愈演愈烈，″泛血管疾病″的概念也被提出并广受关注，这些患者需要更加全面的评估和治疗。既往研究显示同一患者冠状动脉粥样硬化疾病与主动脉疾病的共患率达到73％。
因此，对中老年非急诊的主动脉瘤、主动脉溃疡或夹层的患者建议进行冠状动脉疾病的筛查，避免漏诊并降低冠心病所致的围术期心梗风险。
同理，对于拟行经皮冠状动脉介入治疗(PCI)的患者，必要时也需要进一步评估主动脉病变情况，如胸主动脉穿通性溃疡、主动脉夹层，此时务必完善主动脉CTA检查，充分的术前检查有助于减少漏诊并降低主动脉破裂及出血的风险。
传统的分次手术：按照传统思路，对于同时患有需要介入治疗的冠心病和主动脉疾病(主动脉瘤/主动脉溃疡或夹层等)的患者，通常是在血管外科行主动脉腔内修复术(EVAR)，而在心内科行经皮冠状动脉介入治疗(PCI)。两次手术各自独立实施。
这种传统的逐一就诊模式的优点在于一次手术只处理一种病变，手术和麻醉时间短，但其弊端则包括：
(1)存在治疗矛盾：PCI术前需要强化抗血小板，这将增加主动脉夹层或溃疡破裂及出血风险，甚至危及生命；而在主动脉腔内修复术中又担心未处理的冠心病所致的缺血甚至心梗的风险。
(2)患者依次到两个病房住院，先后接受次两麻醉、两次手术、两次围手术期治疗，这些都可能导致住院时间延长和住院费用的增长，风险增大，增加医疗资源消耗。
我们已经开始了对泛血管疾病领域的探索，但目前针对主动脉疾病合并冠心病的患者的一站式腔内介入治疗却少有文献报道。
发明内容：
本发明的目的在于提供肝素或阿司匹林在制备主动脉腔内修复的药物中的应用。
本发明的目的在于提供一种主动脉和冠状动脉疾病一站式腔内介入的手术方法，即依次对病人实施主动脉腔内修复术和经皮冠状动脉介入治疗。
具体而言，本发明提供的主动脉和冠状动脉疾病一站式腔内介入的手术方法，是依次对病人实施主动脉腔内修复术和经皮冠状动脉介入治疗。
上述的手术方法中，所述手术在病人单次麻醉过程中完成。
上述的手术方法中，所述麻醉为全身麻醉。
上述的手术方法中，所述主动脉腔内修复术为放置主动脉支架。
上述的手术方法中，所述手术只采用股动脉作为入路。
上述的手术方法中，所述手术的术前给予病人阿司匹林。
上述的手术方法中，所述阿司匹林的剂量为100mg/天·次，给药时间为1-30天。
上述的手术方法中，所述主动脉腔内修复术的术中，给予病人普通肝素。
上述的手术方法中，所述肝素给药期间需要进行全血凝血时间(ACT)的监测。
在医学分科越来越细越来越专的今天，我们逐渐认识到患者是一个整体。我们对疾病的认识，更应该从患者的角度出发，若同一患者合并多种疾病，我们应当多科协作，全面评估，争取为患者提供个体化、一站式的医疗服务，这也是现代医疗的发展趋势。
对于同时存在主动脉疾病及冠状动脉疾病的患者，我们组建了由血管外科和心内科联合的专家团队，并已探索了多例主动脉和冠状动脉疾病一站式腔内介入的手术方法的一站式治疗。这种一站式治疗的优势在于：
(1)两种疾病一站式处理，既避免了分次手术时抗血小板治疗上的矛盾，也避免了分次手术时另一种疾病所带来的潜在风险；
(2)患者只经历一次麻醉和一次手术过程，就能治疗两种疾病，心理更容易接受；
(3)降低住院费用，缩短ICU时长及总住院时长，降低医疗资源消耗。
而这种一站式治疗的难度在于：
(1)需要两个科室专家组成复合技术团队，对医院相关学科的技术水准和协调配合能力要求较高；
(2)两种疾病同期处理，短时间内使用的造影剂总量增大，可能增加造影剂相关的不良反应；
(3)冠脉介入治疗围术期要求双联抗血小板治疗降低血栓风险；主动脉腔内修复术入路(如股动脉手术切口)更容易出现术后出血、皮下瘀斑、局部血肿、假性动脉瘤等出血风险。
因此，EVAR和经皮冠状动脉介入治疗两种术式的衔接以及围术期的抗栓治疗方案成为关键。针对这个问题，我们制定一套合理而可行的，针对主动脉和冠状动脉疾病一站式腔内介入的手术方法的一站式治疗的抗栓方案。同时，我们也将围术期大出血作为主要观察终点，对比主动脉和冠状动脉疾病一站式腔内介入的手术方法的一站式治疗较分站式治疗的的安全性。
实施本发明具有以下优势：(1)两种疾病一站式处理，既避免了分次手术时抗血小板治疗上的矛盾，也避免了分次手术的潜在风险；(2)患者只经历一次麻醉和手术过程，治疗两种疾病，心理更容易接受；(3)降低住院费用，缩短ICU时长及总住院时长，降低医疗资源消耗。
附图说明
图1、主动脉及冠状动脉示意图
具体实施方式
以下是结合主动脉和冠状动脉疾病一站式腔内介入的手术方法的实验例证，这些例证是为了说明本发明而不是限制本发明。
实验例1
患者男性，78岁，诊断冠心病合并主动脉夹层(III型)，先由外科医生行主动脉腔内修复术，于降主动脉置入支架一枚；随即同台行冠状动脉造影提示钝缘支重度狭窄并置入支架一枚。手术顺利，术后恢复良好，未发生大出血事件，随访1年未发生出血和急性心梗等。
实验例2
患者男，75岁，诊断冠心病合并主动脉壁内血肿，在全麻下先经右侧股动脉入路行主动脉腔内修复术：于降主动脉置入支架一枚。随后经同一入路行冠状动脉造影并行前降支介入治疗。过程顺利。术后未发生大出血事件，未发生急性心梗等事件。
实验例3
患者男，61岁，诊断主动脉夹层合并冠心病。在全麻下经右侧股动脉入路行主动脉腔内修复术。随后经同一入路行冠状动脉造影提示前降支狭窄，于前降支植入支架1枚。过程顺利。术后未发生大出血事件，未发生急性心梗等事件。
Claims (9)
1.肝素或阿司匹林在制备主动脉腔内修复的药物中的应用。
2.根据权利要求1所述的应用，其特征在于，所述肝素给药期间需要进行全血凝血时间(ACT)的监测。
3.根据权利要求1所述的应用，其特征在于，依次对病人实施主动脉腔内修复术和经皮冠状动脉介入治疗。
4.根据权利要求1-3任一所述的应用，其特征在于，所述主动脉腔内修复术和经皮冠状动脉介入治疗，在病人单次麻醉过程中完成。
5.根据权利要求4所述的应用，其特征在于，所述麻醉为全身麻醉。
6.根据权利要求1-5任一所述的应用，其特征在于，所述主动脉腔内修复术为放置主动脉支架。
7.根据权利要求1-5任一所述的应用，其特征在于，所述主动脉腔内修复术只采用股动脉作为入路。
8.根据权利要求1-5任一所述的应用，其特征在于，所述阿司匹林的剂量为100mg/天·次，给药时间为1-30天。
9.根据权利要求1-5任一所述的手术方法，其特征在于，所述主动脉腔内修复术的术中，给予病人普通肝素。
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