心脏瓣膜置换患者围手术期凝血功能的变化  

The blood coagulation function changes and its mechanism during perioperation in patients undergoing mechanical heart valve replacement surgery

作　　者：侯立仁[1] 韩培立[2] 李强[3] 杨双梅[1] 

机构地区：[1]新乡医学院第一附属医院麻醉科,河南卫辉453100 [2]新乡医学院第一附属医院心外科,河南卫辉453100 [3]新乡医学院第一附属医院中心实验室,河南卫辉453100

出　　处：《中国医师进修杂志》2007年第4期7-9,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察心脏瓣膜置换患者围手术期凝血功能的变化特点,探讨其血液保护措施。方法选择20例择期行心脏机械瓣膜置换术的患者。测定围手术期不同时间点的血小板计数（Pt）、全血激活凝固时间（ACT）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、抗凝血酶Ⅲ活性（AT-Ⅲ）、组织纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制物（PAI）和D-二聚体（D-Dimer）。分析各凝血指标的变化规律。结果Pt、AT-Ⅲ在术中、术后减少（P〈0.05）;ACT在术后48h时缩短（P〈0.05）;PT和APTT在术后2h延长（P〈0.05）,48h缩短（P〈0.05）;术后t-PA、D-Dimer增高（P〈0.05）、PAI降低（P〈0.05）。结论机械瓣膜置换术后的24h内机体处于低凝状态,易发生非外科性出血;24～48h逐渐进入明显的高凝状态,应适时抗凝治疗。　Objective To investigate the changes of coagulation function and its mechanism in patients undergoing mechanical heart valve replacement and discuss the measures of its protection. Methods To select 20 cases of patients undergoing mechanical heart valve replacement. Blood samples were taken from jugular vein to assay platelet count（Pt）,activated coagulation time（ACT）,plasma prothrombin time （PT）,activated partial thromboplastin time（APTT）,antithrombin Ⅲ activity（AT-Ⅲ）,tissue type plasminogen activator（t-PA）,plasminogen activator inhibitor（PAI） and D-Dimer. Results Pt and AT-Ⅲ significantly decreased during operation and after operation（P〈0.05）. ACT significantly decreased 48 h after operation（P〈0.05）. PT and APTT significantly increased at 2 h after operation（P〈0.05）,but they decreased at 48 h（P〈0.05）. After operation t-PA and D-Dimer significantly increased（P〈0.05）,PAI decreased（P〈0.05） . Conclusions The blood is in hypocoagulable state during 24 h after operation and in hypercoagulable state after operation 24-48 h undergoing mechanical heart valve replacement patients.

关 键 词：心脏瓣膜 心肺转流术 凝血功能 围术期 

分 类 号：R65[医药卫生—外科学]