术后不同程度凝血功能障碍对体外循环心脏手术患者短期预后的影响  

Effects of different degrees of coagulation disorders after surgery on short-term prognosis in patients undergoing cardiac surgery with cardiopulmonary bypass

作　　者：陈益君[1] 周海东[1] 朱浩[1] 黄长顺[1] Chen Yijun;Zhou Haidong;Zhu Hao;Huang Changshun(Department of Anesthesiology, Ningbo First Hospital, Ningbo 315010, China)

机构地区：[1]宁波市第一医院麻醉科,315010

出　　处：《中华麻醉学杂志》2017年第12期1489-1492,共4页Chinese Journal of Anesthesiology

基　　金：浙江省中医药科学研究基金（2015ZA186,2012ZB145）

摘　　要：目的评价术后不同程度凝血功能障碍对体外循环心脏手术患者短期预后的影响。方法回顾性分析2010年2月至2015年2月体外循环下心脏手术患者410例，年龄18～79岁，性别不限，BMI 16～28 kg/m^2，ASA分级Ⅲ或Ⅳ级。全麻诱导气管插管术后行机械通气，采用静吸复合麻醉。根据术后6 h时凝血功能将患者分为3组：凝血功能正常组（n＝55）、凝血功能轻度障碍组（n＝237）和凝血功能重度障碍组（n＝118）。收集术后机械通气时间、ICU停留时间、住院时间和住院期间并发症的发生情况。结果与凝血功能正常组比较，凝血功能轻度障碍组住院时间延长，出院延迟率升高，凝血功能重度障碍组机械通气时间、ICU停留时间和住院时间延长，拔除气管导管延迟率、ICU滞留率和出院延迟率均升高，肝肾功能不全发生率和二次开胸止血发生率升高（P〈0.05），凝血功能轻度障碍组术后并发症发生率差异无统计学意义（P〉0.05）。结论对于体外循环心脏手术患者，术后轻度凝血功能障碍对短期预后无明显影响，而术后重度凝血功能障碍可产生不良预后，应该重视对重度凝血功能障碍的纠正。Objective To evaluate the effects of different degrees of coagulation disorders after surgery on short-term prognosis in patients undergoing cardiac surgery with cardiopulmonary bypass（CPB）.Methods A total of 410 patients of both sexes, aged 18-79 yr, with body mass index of 16-28 kg/m^2, of American Society of Anesthesiologists physical status Ⅲ or Ⅳ, scheduled for elective cardiac surgery with CPB, were enrolled in the study.After induction of general anesthesia, the patients were tracheally intubated and mechanically ventilated.Combined intravenous-inhalational anesthesia was used.The patients were divided into 3 groups according to the coagulation function at 6 h after surgery： normal function group（n=55）, mild disorder group（n=237）and severe disorder group（n=118）. Postoperative mechanical ventilation time, duration of intensive care unit stay, length of hospitalization and complications during hospitalization were recorded.Results Compared with normal function group, the length of hospitalization was significantly prolonged, and the rate of delayed discharge from hospital was increased in mild disorder group, and the ventilation time, duration of intensive care unit stay and length of hospitalization were significantly prolonged, the rate of delayed extubation, rate of prolonged intensive care unit stay and rate of delayed discharge from hospital were increased, and the hepatic and nephritic insufficiency and incidence of re-thoracotomy for bleeding were increased in severe disorder group（P〈0.05）, and no significant change was found in the incidence of postoperative complications in mild disorder group（P〉0.05）.Conclusion For the patients undergoing cardiac surgery with CPB, postoperative mild coagulation disorders exert no effect on short-term prognosis, however, postoperative severe coagulation disorders produce poor prognosis, and correction of severe coagulation disorders should be taken into account.

关 键 词：血液凝固障碍 心肺转流术 心脏外科手术 预后 

分 类 号：R614[医药卫生—麻醉学]