腔内隔绝术中血小板与凝血功能的变化  

Changes of platelet and blood coagulating function during endovascular graft exclusion

作　　者：徐美英[1] 张富军[1] 包俊敏[2] 朱文忠[1] 赵志青[2] 王利丽[2] 景在平[2] 

机构地区：[1]第二军医大学长海医院麻醉科,上海200433 [2]长海医院血管外科

出　　处：《第二军医大学学报》2002年第8期849-851,共3页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金资助项目 (39770 72 1) ;军队杰出人才基金资助项目 (98J0 0 5 ) ;上海市卫生系统百名跨世纪优秀学科带头人培养计划基金 (97BR0 4 7)

摘　　要：目的 :了解腔内隔绝术中患者血小板与凝血功能的变化规律 ,为合理应用肝素、血小板提供依据。 方法 :对 2 0例行腔内隔绝术的大动脉瘤患者 ,应用 Sonoclot血小板与凝血功能监测仪 (SCT) ,测定麻醉诱导后 (T1 )、肝素化后 (T2 )及血管内操作结束后 (T3) 3个时间点激活凝血时间 (ACT)、凝血速率、血小板功能及红细胞比容 (HCT)和血小板计数 (PL T) ,对其变化的原因进行分析。结果 :T1 时点 ACT、凝血速率、血小板功能均在正常范围内 ;0 .3～ 0 .5 mg/ kg肝素化后 (T2 时点 ) ,ACT延长至 (2 89± 6 1.1) s,凝血速率下降 ,血小板功能下降 (P <0 .0 1) ;T3时点虽然 HCT和 PL T分别从 0 .4 1± 0 .0 5和 (183±5 0 .8)× 10 9/ L 下降至 0 .30± 0 .0 3和 (95 .0± 2 8.0 )× 10 9/ L(P<0 .0 5 ) ,但 ACT、凝血速率、血小板功能均恢复至血管内操作前 ,两者比较无显著差异。 结论 :腔内隔绝术患者麻醉后 ACT、凝血与血小板功能正常 ,0 .3～ 0 .5 m g/ kg肝素能防止血管内操作期间血栓形成 ,不增加出血量。血管内操作结束后 ,HCT和 PL T下降 ,但凝血速率、血小板功能均可恢复。Objective:To study the changes of platelet and blood coagulating function during endovascular graft exclusion(EVGE), providing reference for reasonable use of heparin and platelet. Methods:Using sonoclot analysis (SCT), 20 patients accepted EVGE were measured for ACT, clot rate, platelet function and hematocrit (HCT) and platelet count (PLT) after anesthesia induction(T 1), heparination(0.3 0.5 mg/kg)(T 2) and EVGE(T 3), respectively. The reasons for variability were analyzed. Results:ACT, clot rate and blood platelet function were normal at T 1. At T 2 ACT was prolonged [(289± 61.1) s,] clot rate and platelet function were decreased ( P <0.01). At T 3 HCT and PLT were decreased [from 0.41±0.05 to 0.30± 0.03 and from (183±50.8)×10 9/L to (95.0±28.0)×10 9/L]. At T 3, there was no significant difference of ACT, clot rate and platelet function compared with those at T 1. Conclusion:In patients received EVGE, ACT, coagulation and platelet function are normal after anesthesia. Heparination (0.3 0.5 mg/kg) prevents the occurrence of thombosis without increasing hemorrhage. HCT and PLT decrease after endovascular operation, but coagulation and platelet function is recovered. SCT can guide anticoagulation therapy in EVGE reasonably.

关 键 词：腔内隔绝术 血小板 凝血功能 动脉瘤 血小板功能试验 血液凝固 

分 类 号：R543.16[医药卫生—心血管疾病]