开胸患者术后深静脉血栓形成与血液凝血活性的变化  

Incidence of deep venous thrombosis (DVT) in patients undergoing thoracotomy and changes of hemostasis

作　　者：袁训芝[1] 吴新民[1] 陈铭[2] 袁家颖[3] 张生锁[1] 

机构地区：[1]北京大学第一医院麻醉科,北京100034 [2]北京大学第一医院超声诊断科,北京100034 [3]北京大学第一医院检验科,北京100034

出　　处：《北京大学学报（医学版）》2004年第5期529-532,共4页Journal of Peking University:Health Sciences

摘　　要：目的 :调查胸科大手术术后患者下肢深静脉血栓形成的发病情况 ,观察手术前后凝血、纤溶活性的变化。方法 :2 0 0 3年 2月至 4月行肺癌或食管癌根治术的患者 5 2例。年龄 35～ 79岁 ,男 34例 ,女 18例。所有患者于术后 3～ 10天内行双下肢深静脉血管超声检查。同期做了 5 7例非手术门诊患者双下肢血管超声检查。均记录双下肢静脉血流速度及血栓发生的部位。 2 5例开胸手术患者于术前、术后 3天及术后 1周采集静脉血测定纤维蛋白原(fibrinogen ,FIB)、D 二聚体 (D dimer,D D)、抗凝血酶 (antithrombin ,AT)、凝血酶 -抗凝血酶复合物 (thrombin -an tithrombincomplex ,TAT)、纤溶酶原激活剂抑制剂 (plasminogenactivatorinhibitor,PAI)、凝血酶原时间 (prothrombintime ,PT)、国际标准化比值 (internationalnormalizedratio ,INR)以及活化的部分凝血活酶时间 (activatedpartialthromboplastintime,APTT)。所有患者无血栓栓塞史 ,术前评价血栓栓塞发生的风险。结果 :5 2例入选患者中 ,2 8例患者超声检查发现存在深静脉血栓形成 ,血栓检出率为 5 3.8% ,均为腓静脉血栓形成。血凝指标D D、FIB手术后明显升高 ,一直持续到手术后 1周 ;TAT手术后 3天明显升高 ,但手术后 1周恢复到术前水平 ;AT手术后 3天明显降?Objective:To survey the incidence of deep venous thrombosis (DVT) in high risk patients undergoing thoracotomy and observe the changes of hemostatic activity. Methods: Fifty-two consecutive patients (ages that ranged from 35 to 79, 34 men and 18 women) with lung or esophagus cancer were enrolled into this prospective trial. The patients included underwent major thoracic surgery from February 2003 to April 2003. Bilateral lower extremity duplex ultrasonography for DVT screening was performed 3-10 days post surgery in all 52 patients and 57 matched clinic normal controls. Venous blood was collected to determine fibrinogen(FIB), D-dimer(D-D), plasminogen activator inhibitor (PAI), antithrombin (AT), thrombin antithrombin complex (TAT), prothrombin time (PT),international normalized ratio(INR), and activated partial thromboplastin time (APTT) immediately before surgery, the third and tenth days postoperatively. No patient had a prior thromboembotic history. Risk factors for DVT were evaluated. Results: Of the 52 patients, 28 (53.8%) had an acute postoperative DVT detected in the calf. One patient died of suspected pulmonary embolism postoperatively. Plasma levels of FIB and D-D increased significantly up to 7 d after operation. AT level decreased significantly 3 d after operation and returned to normal 7 d latter. TAT increased significantly 3 d post operation and decreased to normal on day 7. PAI level was lowered 3 d after surgery, but increased significantly on day 7 compared with that on day 3. With the addition of risk factors related to thrombosis, the incidence of DVT was increased correspondingly. Conclusion: Of the patients undergoing major thoracic surgery,53.8% of them had a postoperative DVT by postoperative screening duplex ultrasound. In Chinese population, incidence of DVT appears to be high without prophylaxis, which is similar to other reports of westerners. These patients had a number of risk factors for the development of DVT, which include older age, overweight, hypertension, diabetes, and h

关 键 词：患者 手术后 深静脉血栓形成 术前 D-D 开胸 大手术 应考 水平 个数 

分 类 号：R446[医药卫生—诊断学] R543[医药卫生—临床医学]