术前纤维蛋白原单次目标给药对PLIF术中出血及凝血功能的影响  

Effect of preoperative single target administrating of fibrinogen on intraoperative bleeding and coagulation function in PLIF

作　　者：卜文豪[1] 吴群林[1] 骆喜宝[2] 屠伟峰[1] 

机构地区：[1]广州军区广州总医院麻醉科/全军临床麻醉中心,广东广州510010 [2]桂林医学院附属医院麻醉科,广西桂林541001

出　　处：《重庆医学》2015年第10期1334-1336,1339,共4页Chongqing medicine

基　　金：广东省医学科研基金资助项目(A2013440;A2013439)

摘　　要：目的探讨术前纤维蛋白原(FIB)单次目标给药,对腰椎后路减压椎间植骨融合内固定术(PLIF)术中出血及凝血功能的影响。方法选择腰椎间盘突出症(LDH)择期做PLIF的患者60例,依据术前FIB水平分为FIB≥3.0g/L组(NC组,n=20)和低FIB组(FIB<3.0g/L,n=40),低FIB组再分为低FIB对照组(LC组,n=20)和术前FIB单次给药组(PF组,n=20)。PF组于麻醉诱导完成后输入纤维蛋白原;LC、NC组于麻醉诱导完成后输入纤维蛋白原剂量所需溶媒等容积的生理盐水。3组患者于给药前、后测定凝血4项及用凝血和血小板功能分析仪测定激活凝血时间(ACT)、凝血速率(CR)、血小板功能(PF),术毕称量出血量。结果 FIB在给药后PF组为(3.75±0.23)g/L,明显高于NC组(2.62±0.33)g/L和LC组(2.23±0.22)g/L,3组比较差异有统计学意义(P<0.05);CR值在给药后PF组为(21.42±7.15)U/min,高于NC组(18.21±5.62)U/min和LC组(15.21±5.63)U/min。PF组出血量为(516.74±135.53)g,低于NC组(660.71±119.34)g和LC组(726.72±160.47)g,3组比较差异有统计学意义(P<0.05)。结论术前FIB单次目标给药可以有效提高FIB水平及凝血功能,减少围术期出血量。Objective To investigate the effect of preoperative single target administrating of fibrinogen（FIB）on the intraoperative bleeding and coagulation function in posterior lumbar interbody fusion（PLIF）operation.Methods 60 cases of lumbar intervertebral disc herniation（LDH）undergoing elective PLIF operation were divided into two groups according to the preoperative FIB levels：normal control group（NC,FIB≥3.0g/L,n=20）and low FIB group（FIB3.0g/L,n=40）.The low FIB group was randomly re-divided into 2groups：the low HIB control group（LC,n=20）and the preoperative single FIB administrating group（PF,n=20）.After anesthesia induction,the PF group was given FIB;the LC and NC groups were given the same volume of saline solution as solvent volume required by administrating FIB dose.The change of blood coagulation 4indexes were detected and the activated clotting time（ACT）,coagulation time（CR）and platelet function（PF）were detected by the sonoclot analyzer before and after drug administrating.The bleeding amount was weighed after ending operation.Results The FIB concentration after administrating in the PF group was（3.75±0.23）g/L,which was significantly higher than（2.62±0.33）g/L in the NC group and（2.23±0.22）g/L in the LC group,the differences among 3groups were statistically significant（P〈0.05）;the CR value after administrating in the PF group was（21.42±7.15）U/min,which was higher than（18.21±5.62）U/min in the NC group and（15.21±5.63）U/min in the LC group.The bleeding amount in the PF group was（516.74±135.53）g,which was lower than（660.71±119.34）g in the NC group and（726.72±160.47）g in the LC group,the difference among 3groups had statistical significance（P〈0.05）.Conclusion Preoperative single target administrating of fibrinogen can effectively increase the FIB level,improve the blood coagulation function and reduce the periaoperative bleeding amount.

关 键 词：纤维蛋白原 手术期间 出血 凝血酶时间 部分促凝血酶原时间 凝血酶原时间 

分 类 号：R614[医药卫生—麻醉学]