长时间手术凝血功能变化规律的研究  

Rules of sequential changes in haemostatic activity during prolonged surgery

作　　者：赵鑫[1] 王志刚[1] 李海博[2] 张东海[1] 谢坤[1] 类维富[3] 

机构地区：[1]山东大学第二医院麻醉科,山东济南250033 [2]济南市中心医院手术室,山东济南250013 [3]山东大学齐鲁医院麻醉科,山东济南250012

出　　处：《山东大学学报（医学版）》2005年第8期760-762,共3页Journal of Shandong University:Health Sciences

摘　　要：目的:探讨长时间手术过程中患者凝血功能变化的规律。方法:随机将20例头颈部恶性肿瘤手术患者分为对照组(A组,n=10)和肝素组(B组,n=10)。B组自肿瘤切除后持续静脉投入小剂量肝素,使部分活化凝血活酶时间(APTT)稳定在50～70s。两组患者自麻醉开始到手术结束,每2h采集1次静脉血检测血常规、PT、纤维蛋白原APTT、Fbg、抗凝血酶Ⅲ(AT-Ⅲ)、凝血酶原片段(F1+2)、D-二聚体(D-D)。结果:与麻醉开始时比较,两组患者4～6h后PT缩短,Fbg增高,AT-Ⅲ降低,F1+2与D-D增加,差异有统计学意义(P<0.05)。B组应用肝素后,F1+2与D-D开始降低,并明显低于同时点的A组(P<0.05)。结论:随着手术的进行,患者血液凝固、纤溶功能增强,6h后出现血栓前状态,小剂量肝素可改善血栓前状态。Objective： To explone the rules of sequential changes in haemostatic activity during in prolonged surgery. Methods： Twenty patients undergoing prolonged surgery of otolaryngology, teratology and neurosurgery under general anesthesia were randomly assigned to group A （n=10）, and group B （n=10） which was continuously infused small dosage of heparin to maintain APTT between 50 to 70 seconds after the tumor removed until the end of anesthesia. All the patients were drawn blood examples and determined the blood routine, PT, APTT, Fbg, AT-Ⅲ, F1＋2 and D-Dimer every 2 hours from the beginning until the end of anesthesia. Results： Compared with the beginning of anesthesia, 4～6 hours later, PT was shorter, Fbg was higher, AT-Ⅲ was lower, F1＋2 and D-D were higher in both groups （P〈0.05）. Compared with group A, F1＋2 and D-D were clearly inhibited after heparin was injected into group B （P〈0.05）. Conclusion： From the early of surgery, patients have increased haemostatic activity; 6 hours later, they are in prethrombotic state, which can be suppressed by a small dosage of heparin.

关 键 词：外科手术 血液凝固 血栓前状态 肝素 

分 类 号：R331.1[医药卫生—人体生理学]