体外循环心脏手术围术期纤溶系统变化的探讨  

An Investigation for the Mobility of Fibrinolysis System During the Cardiosurgery Extracorporeal Circulation Period

作　　者：江虹[1] 陈川[1] 贾劲[1] 周静[1] 韩帅[1] 廖娟[1] 王霞[1] 

机构地区：[1]四川大学华西医院实验医学科临检血液室,成都610041

出　　处：《血栓与止血学》2007年第5期218-220,共3页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的了解体外循环心脏手术围术期机体纤维蛋白溶解系统的变化规律,为临床抗纤维蛋白溶解和体外循环心脏手术围术期用药的监测提供实验依据。方法对79例心脏瓣膜置换术患者根据抗纤溶药物的使用被随机分为2组,即6-氨基己酸组(39例)和抑肽酶组(40例)。为观察患者围术期机体纤溶系统的变化,测定两组患者手术前、手术中主动脉开放后、手术后72h三个时间点外周血中D-二聚体、α2-抗纤溶酶水平。结果(1)横向比较:术前6-氨基己酸组与抑肽酶组血浆中D-二聚体与α2-抗纤溶酶水平(组间)比较均无统计学差异,P>0.05;术中主动脉开放后两组D-二聚体与α2-抗纤溶酶水平比较均有统计学差异,P<0.05;术后72h两组D-二聚体与α2-抗纤溶酶水平比较均无统计学差异,P>0.05。(2)纵向比较:6-氨基己酸组和抑肽酶组(组内)术前与术后D-二聚体与α2-抗纤溶酶水平比较均无统计学差异,P>0.05;而术前与术中、术中与术后72hD-二聚体与α2-抗纤溶酶水平比较均有统计学差异,P<0.05。结论(1)将两组患者术前与术中、术中与术后72hD-二聚体和α2-抗纤溶酶水平分别进行比较,可见其存在较大幅度的波动,这一变化提示围手术期机体纤溶系统存在明显改变,因此应在术中及术后密切监测其变化。(2)横向比较6-氨基己酸组与抑肽酶组纤溶指标,术中主动脉开放后D-二聚体与α2-抗纤溶酶水平都存在显著差异,但术后72h无明显差异,说明两种抗纤溶治疗方式对手术过程中机体纤溶系统的影响是有差别的,而对术后的影响无明显差异。Objective To find the mobility rule of fibrinolysis system for patient during the cardiosur- gery extracorporeal circulation period in order for the drugmonitoring to based on . Methods 79 valve replacement patient were divided into two groups according to the antifibrinolytic agent they used. D-dimer,α2-AP were analyzed before the operation,aorta opened during the operation, and 72 hr after the surgery . Resuits （1） Transversal comparison ： for patient use 6-aminohexanoic acid and aprotinin, before the operation , for both D-dimer and α2-AP , the difference between two groups have no statistics discrepancy, P 〉 0.05 ; while aorta opened during the operation, there is statistics discrepancy, P 〈 0.05 ; 72 h after the surgery , the difference between two groups have no statistics discrepancy, P 〉 0.05 .（2） Comparison ： for both 6- amin- ohexanoic acid and aprotinin groups, D- dimer and α2- AP have no statistics discrepancy, P 〉 0.05, but there is statistics discrepancy for D-dimmer before and during the operation, and there is also statistics discrepancy for D- dimmer during and after the operation. Conclusion （1） From the comparison , there is significant variation, which indicate the alteration of fibrinolysis system, so ,it should be close monitored. （2） From the transversal comparison, it indicate there is differential between these two anti- fibrinolysis therapy during the operation, while after the operation, there is not.

关 键 词：纤溶系统 D-二聚体 Α2-抗纤溶酶 抑肽酶 6-氨基己酸 

分 类 号：R446.1[医药卫生—诊断学]