经血栓弹力图检测的梗阻性黄疸患者血凝动力学紊乱  

Dynamic disorders of coagulation through the detection of thromboelastography in obstructive jaundice patients

作　　者：王新波[1] 王思珍[1] 戴洪山[1] 韩建明[1] 黎介寿[1] 

机构地区：[1]南京军区南京总医院解放军普通外科研究所,江苏南京210002

出　　处：《肝胆胰外科杂志》2011年第4期272-274,277,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的通过血栓弹力图检测探究早期梗阻性黄疸对患者凝血功能的影响。方法前瞻性连续分析31例梗阻性黄疸患者与15例非黄疸患者的常规凝血指标、血常规、肝功能及血栓弹力图。结果两组患者的肿瘤类别、年龄等基本资料无统计学差异,黄疸时间为(22±24)d。常规凝血检测结果两组间未见明显差异;尽管梗阻性黄疸组患者血小板数量与无黄疸组相比无统计学差异,但血栓弹力图(TEG)检测提示,反应血凝块最大强度及血凝块形成的稳定性的MA值两组间有统计学差异(P<0.01),其80%取决于血小板功能,同样反映血小板数量与功能的指标G值和A值,两组间均有统计学差异(P<0.01)。而其他TEG指标未见明显统计学差异。结论与传统梗阻性黄疸患者存在出血倾向的观点不同,我们观察到梗阻性黄疸患者早期处于一定的高凝状态,并与血小板功能亢进有关。血栓弹力图检测发现黄疸患者早期血凝动力学紊乱状态,主要表现与血小板功能亢进有关。Objective To investigate the effect of clotting function through the detection of thromboelastography in patients with obstructive jaundice in early stage.Methods Liver function tests,standard coagulation parameters and hemogram were perspectively analyzed in consecutive 31 patients with obstructive jaundice and 15 patients without jaundice.Thromboelastography（TEG） was used for the evaluation of coagulation dynamics.Results There was no difference of the mean values of clinical characteristics,concurrent diseases and standard coagulation parameters between two groups.The duration of jaundice was（22±24）d.Although there was no significantly difference in the number of platelets due to the blood routine test,the MA values which indicate the maximum strength of coagulum were significantly different between two groups.And the values in jaundiced patients were much higher than the patients in control group（P=0.001）.The G and A values which indicate the elasticity of coagulum showed the same tendency like MA values.Values of G and A were also considered statistically difference between two groups（P=0.001,P=0.001 respectively）.Other parameters in TEG in jaundice group were similar to that of the control group（P0.05）.Conclusion The most probable cause of dynamic disorders of coagulation through the detection of thromboelastography in obstructive jaundice patients is the increased function of platelet in blood.

关 键 词：梗阻性黄疸 凝血功能 血小板功能 血栓弹力图 

分 类 号：R575[医药卫生—消化系统]