体外循环术后纤溶调节系统紊乱的影响因素  

Factors Affecting Fibrinolytic Regulatory Imbalance After Cardiopulmonary Bypass

作　　者：辛英才[1] 王京生[1] 

机构地区：[1]北京医科大学人民医院心血管外科

出　　处：《中华胸心血管外科杂志》1998年第4期220-223,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：观察术后纤溶系统及抗凝系统的变化，以找出体外循环（ＣＰＢ）术后出血增多和纤溶调节紊乱的影响因素，为临床治疗提供理论依据。根据ＣＰＢ运转时间将３０例ＣＰＢ心脏手术病人分为两组（Ｉ组＜１２０分钟，Ｉ组≥１２０分钟），比较两组在术前、术后１、６、１２、２４、４８和７２小时７个时点时ＰＡＩ、ｔＰＡ、ＰＬＧ、ＡＴＰＬ、ＰＣ、ＰＳ、ＡＰＣ和术后引流量８项指标，观察其变化规律，分析相互关系。结果ｔＰＡ术后显著增高，由术前１１．７２±６．６ｎｇ／ｍｌ到术后６小时２３．７±４．３ｎｇ／ｍｌ，约为术前的２倍（Ｐ＜０．０１）。ＰＡＩ与ｔＰＡ相反，术前２８．９±６．１ｎｇ／ｍｌ，术后１小时降至１６．０±１６．５ｎｇ／ｍｌ（Ｐ＜０．０１），仅为术前水平的４５％。相关分析显示ＡＰＣ与ＰＡＩ呈负相关（Ｐ＜０．０１）。分组比较，ＰＡＩ术前Ｉ组显著高于Ｉ组（Ｐ＜０．０５），Ｉ组术后１小时明显降低（Ｐ＜０．０５），而Ｉ组术后各时点比较无差异。结论：（１）纤溶亢进的机制是ｔＰＡ和ＰＡＩ的平衡失调造成的，ＰＡＩ的降低可能是造成术后早期引流量增多的主要因素之一。延长ＣＰＢ时间可显著地影响ＰＡＩ的变化。（２）术后ＰＣ系统变化与纤溶增强有关，ＡＰＣ与Ｐ?Aim:To evaluate the effects of cardiopulmonary bypass(CPB)on fibrinolytic regulation imbalance and relationship between fibrinolysis and anticoagulative system.Clinical material and method:30 patients undergoing open heart surgery under CPB were studied.Blood samples were drawn preoperatively,and 1,6,12,24,48 and 72 hours postoperatively for assessing PAI,tPA,PLG,ATPL,PC PS and APC.According to duration of CPB time,patients were divided into group I(CPB time<120 minutes)and group II(CPB time >120 minutes).Result:Before CPB,PAI was much higher in group II than that in group I(31.3±5.7ng/ml vs. 25.7±5.3ng/ml,P<0.05).After CPB,tPA was significantly elevated from 11.7±6.6ng/ml to 23.7±4.3ng/ml(P<0.01)and PAI was markedly reduced from 28.9±6.1ng/ml to 16.0±16.5ng/ml(P<0.01).Correlative analysis showed that there was a negative relation between PAI and APC(P<0.001).APC was also correlated to PLG and ATPL(P<0.01).Conclusion:Hyperfibrinolysis after CPB is closely related to imbalance of tPA and PAI.Prolonged CPB could significanlty reduce PAI level and result in more blood loss.

关 键 词：体外循环 抗凝系统 纤溶调节 影响因素 

分 类 号：R654.1[医药卫生—外科学]