非体外循环冠脉搭桥术后不同治疗方案对凝血功能的影响  

Effects of Different Treatments on the Coagulation Function after Off-Pump Coronary Artery Bypass Grafting

作　　者：钱兆洋[1] 王赞鑫[1] 姜月梅[1] 门剑龙[2] 魏民新[1] 

机构地区：[1]天津医科大学总医院心血管外科,300052 [2]天津医科大学总医院检验科,300052

出　　处：《天津医药》2013年第6期531-534,共4页Tianjin Medical Journal

基　　金：国家自然科学基金委员会资助项目(项目编号:81041042);天津市应用基础及前沿技术研究计划(项目编号:10JCZDJC19200);天津市卫生局科技攻关计划(项目编号:11KG134)

摘　　要：目的探讨不同治疗方案对非体外循环冠状动脉搭桥术(OPCAB)后VII因子(FⅦ)、血管性血友病因子(vWF)、D-二聚体(D-dimer)和纤溶酶原激活物抑制物-1(PAI-1)的影响。方法根据阿司匹林和低分子肝素联合使用时间将60例OPCAB患者随机分为A、B组。于术前及术后4、14d,采用酶联免疫吸附试验(ELISA)发色底物法检测FVII和vWF,双抗体夹心法测定PAI-1,免疫渗滤法检测D-dimer。术后1、3个月门诊复查D-dimer,并进行比较分析。结果术后4d2组患者FVII降低,vWF和PAI-1升高,均于术后14d基本恢复至术前水平(均P<0.05),3个指标组间差异无统计学意义(均P>0.05)。D-dimer术后4d^1个月显著升高,术后3个月时降至接近术前水平。且除术后14d、1个月B组明显低于A组外,其余时点2组间差异均无统计学意义(P>0.05)。结论 OPCAB后患者出现一定程度的凝血、纤溶亢进状态,术后延长低分子肝素使用时间对FⅦ、vWF和PAI-1在术后14d内变化影响不明显,可降低D-dimer。Objective To investigate effects of different treatment options on the influence of factor VII （F VII）, Von Willebrand factor （vWF）, D-dimer and plasminogen activator inhibitor-1 （PAI-1） after off-pump coronary artery bypass grafting （OPCAB）. Methods Sixty patients were divided into two groups： A group and B group, according to the using time of low-molecular-weight heparin （LMWH） and aspirin, The levels of FVII and vWF were examined by ELISA-chromogenic substrate method before operation, 4-d and 14-d after operation. The level of PAI-1 was detected by sandwich technique, and D-dimer was detected by immunogold filtration assay. The level of D-dimer was reviewed in 1 month and 3 months after surgery. All results were analyzed between two groups. Results The value of FVHdecreased significantly 4-d after operation in two groups of patients, vWF and PAI-1 increased significantly and returned to preoperative level on the 14-d after opera- tion （P 〈 0.05）. There were no significant differences in three indicators between two groups （P 〉 0.05）. The level of D-dimer increased until 1 month after surgery and went back to preoperative level in 3 months after operation. There was a significant- ly lower level of D-dimer in B group than that of A group on the 14＇h day and 1 month after surgery （P 〈 0.05）. Conclusion Patients have higher levels of coagulation and fibrinolysis function after OPCAB. Postoperative extend the use of LMWH has no impact on FV][, vWF and PAI-1 in 14 days after surgery, but which can reduce the level of D-dimer.

关 键 词：冠状动脉旁路移植术 非体外循环 肝素 低分子量 因子Ⅶ von WILLEBRAND因子 纤溶酶原激活物抑制物1 D-二聚体 

分 类 号：R654.2[医药卫生—外科学]