凝血试验预测口腔颌面外科手术出血的价值  

The Value of Coagulation Tests in Predicting the Risk of Hemorrhage in Major O- ral and Maxillofacial Operations

作　　者：纪均[1] 张凌[1] 姜虹[1] 朱也森[1] 

机构地区：[1]上海第二医科大学附属第九人民医院麻醉科,上海200011

出　　处：《中国临床医学》2005年第1期153-155,158,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:评估术前常规凝血试验(coagulation tests,CTs)预测口腔颌面外科手术出血的价值。方法:对2002年12月- 2003年12月接受口腔颌面外科大手术的387例病人进行回顾性研究,通过术前常规CTs筛选出12例凝血功能异常的病人并匹配24例对照,对两组间出血相关临床事件及手术时间、术中失血和输血量进行分析。结果:凝血功能异常的发病率为3.10%,其中血小板计数(PC)异常的发生率为2.07%,凝血酶原时间(PT)和活化部分凝血活酶时间(aPTT)异常的发生率为1.34%,CTs筛选出的无任何临床症状和体征的凝血功能异常为1.29%(5/387)。病例组和对照组相比,在延缓手术或改变手术方式(66.7%vs.0%,P=0.000016)、术中术后全身使用生物止血剂(58.3%vs.8.3%,P=0.0025)等方面存在显著差异, 病例组平均手术时间明显短于对照组(5.77±1.37h vs.5.84±2.54h,P<0.01);而在术中因失血引起低血压(16.7%vs. 4.2%,P=0.28),因出血再次手术(8.3%vs.4.2%,P=0.56),因出血导致死亡(8.3%vs.0%,P=0.33)及术中失血和输血量无显著差异(P>0.05)。结论:口腔颌面外科术前常规CTs检查不能预测多数和术中出血相关的临床事件的发生,但对术前已有凝血功能异常病史和症状、体征的患者,CTs的结果能反映凝血功能异常的程度,对预测可能出现的出血性并发症有一定的?Objective: To evaluate the value of coagulation tests in predicting the risk of hemorrhage in major oral and maxillofacial operations. Methods: The platelet count (PC). prothrombin time (PT) and activated partial thromboplastin (aPTT) of 387 patients undergoing major oral and maxillofacial operations from 12/2002 to 12/2003 were reviewed. 12 patients with abnormal results were screened out as study group. For each of these patients,another 24 control patients undergoing the same surgery and matched for age and gender were identified. Comparison was made regarding the incidence of perioperative bleeding correlated clinical affairs blood loss amamt, blood tramsfusion amount between two groups. Results: The overall incidence of abnormality was 3. 10% , the incidence of abnormal PC was 2. 07% and the incidence of abnormal PT and aPTT was 1.34%. Only 5 patients (1. 29% ,5/387) with thrombocytopenia or prolonged PT and aPTT who had no clinical symptoms, signs and history were found. Although study group patients had more probability to delay the operations or change the protocol of operation (66.7% vs. 0% ,P = 0. 000016) and use of biological hemostatics (58.3% vs. 8. 3 % , P = 0. 0025), the incidence of other clinical affairs was not different significantly. Conclusion: Routine preoperative coagulation tests of patients undergoing major oral and maxillofacial operations can not predict the risk of perioperative hemorrage. But for abnormal patients with clinical symptoms,signs and history,the results of tests can indicate the degree of coagulation abnomahty and be of certain value to predict the probability of bleeding complications.

关 键 词：口腔颌面外科 凝血功能 CT 手术出血 术前 术中失血 对照组 预测 价值 中因 

分 类 号：R446[医药卫生—诊断学] R782[医药卫生—临床医学]