Abstract: Objective To study the related influencing factors of high on-treatment platelet reactivity (HTPR) in patients after coronary artery bypass grafting (CABG) in order to provide references for postoperative drug application. Methods A total of 144 patients who successfully completed CABG and were treated with clopidogrel and aspirin after surgery in The First Affiliated Hospital of Henan University of Science and Technology from January 2017 to June 2020 were selected as the research subjects, including 110 males and 34 females, aged (55.85± 7.18) years. The clinical data of all patients were collected. According to the inhibition rate of platelet aggregation, they were divided into a normal on-treatment platelet reactivity (NTPR) group (116 patients) and a HTPR group (28 patients). Independent sample t test was used for comparison of the measurement data between groups, χ2 test or Fisher's exact probability method was used for comparison of the count data between groups, and univariate and multivariate analysis were used to screen the possible risk factors of HTPR in patients. Results The age of patients undergoing CABG was significantly different between the two groups (χ2 =19.153, P<0.001). The preoperative serum creatinine level in the HTPR group was (74.52±9.84) μmol/L, which was lower than that in the NTPR group [(83.68±13.47) μmol/L], with a statistically significant difference (P<0.05). There were statistically significant differences in the operation time and 24 h drainage volume between the two groups (χ2 =8.329, 12.758, both P<0.05). The blood clot motility (K) and blood clot intensity (MAADP) of the HTPR group were (1.50±0.37) min and (49.84±6.28) mm, respectively, which were higher than those of the NTPR group [(1.21±0.24) min and (37.54±5.41) mm]; the blood clot dynamics (Alpha), blood clot intensity (MAthrombin), coagulation composite index (CI), and the inhibition rate of arachidonic acid (AA) were (69.47±2.41)° , (64.24±2.51) mm, (1.85±0.54), and (63.28±18.63)% , respectively, which were lower than those of the NTPR group [(72.85±2.31)° , (66.86±2.74) mm, (2.97±0.92), and (79.74±16.59)%], with statistically significant differences (all P<0.05). Multivariate analysis showed that age, gender, AA inhibition rate, and serum creatinine were risk factors for HTPR (all P<0.05). Conclusion Age, gender, AA inhibition rate, and serum creatinine are risk factors for HTPR in patients after CABG, and corresponding prevention should be carried out to reduce the risk of HTPR in patients.

Key words: Coronary artery bypass grafting, Antiplatelet drugs, Reactivity, Risk factors

摘要： 目的 研究冠状动脉旁路移植术（CABG）后患者出现血小板高反应性（HTPR）的相关影响因素，旨在为术后用药提供参考。方法 选取2017年1月至2020年6月河南科技大学第一附属 医院成功完成 CABG，术后使用氯吡格雷、阿司匹林治疗的 144例患者作为研究对象，其中男 110例， 女 34例，年龄（55.85±7.18）岁，收集所有患者临床资料，按血小板聚集抑制率分为正常血小板反应性 （NTPR）组116例、HTPR组28例。计量资料组间比较采用独立样本t检验，计数资料组间采用χ2 检验或 Fisher确切概率法，单因素、多因素分析筛选患者 HTPR 的可能危险因素。结果 两组CABG患者年龄比较，差异有统计学意义（χ2 =19.153，P<0.001）。HTPR组术前血肌酐指标为（74.52±9.84）μmol/L， 低于 NTPR 组（83.68±13.47）μmol/L，差异有统计学意义（P<0.05）。两组 CABG 患者手术时间、24 h引流量比较，差异均有统计学意义（χ2 =8.329、12.758，P<0.05）。HTPR组血块动力（K）、血块强度（MAADP） 分别为（1.50±0.37）min、（49.84±6.28）mm，均高于NTPR组（1.21±0.24）min、（37.54±5.41）mm，血块动力 （Alpha）、血块强度（MAthrombin）、凝血综合指数（CI）、花生四烯酸（AA）抑制率分别为（69.47±2.41）°、 （64.24±2.51）mm、（1.85±0.54）、（63.28±18.63）%，均低于 NTPR 组（72.85±2.31）°、（66.86±2.74）mm、 （2.97±0.92）、（79.74±16.59）%，差异均有统计学意义（均P<0.05）。多因素分析发现，年龄、性别、AA抑 制率、血肌酐为 HTPR 的危险因素（均 P<0.05）。结论 年龄、性别、AA 抑制率、血肌酐为 CABG 术后患者出现HTPR的危险因素，需进行相应预防，以期减少患者HTPR发生风险。

关键词: 冠状动脉旁路移植术, 抗血小板药物, 反应, 危险因素