腹主动脉下段球囊临时阻断术纤维蛋白原及内生肌酐清除率的变化及临床意义  

Change and clinical significance of fibrinogen and creatinine clearance rate in the temporary balloon occlusion of the lower abdominal aorta

作　　者：郑毅[1] 李期熠 郑志勇[1] 蓝宇俭 叶奕晖 覃晓[2] 侯培勇[1] ZHENG Yi;LI Qi-yi;ZHENG Zhi-yong;LAN Yu-jian;YE Yi-hui;QIN Xiao;HOU Pei-yong(Department of Vascular Surgery, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, China;Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China)

机构地区：[1]广西医科大学第四附属医院血管外科,广西柳州545005 [2]广西医科大学第一附属医院血管外科,南宁530021

出　　处：《中国血管外科杂志（电子版）》2018年第4期265-269,共5页Chinese Journal of Vascular Surgery(Electronic Version)

基　　金：广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170907)

摘　　要：目的探讨彩色多普勒引导腹主动脉下段球囊临时阻断术时纤维蛋白原(FIB)及内生肌酐清除率(Ccr)水平的变化及临床意义。方法回顾性分析2015年5月至2016年12月广西医科大学第四附属医院收治的58例难治性盆腔类手术患者的临床资料,包括骨盆骨折11例、凶险性前置胎盘并发胎盘植入22例、骶骨肿瘤切除术12例、盆腔肿瘤切除术13例。患者均给予腹主动脉下段球囊临时阻断术,分别于术前、球囊阻断时、术后的血液样本对FIB及Ccr进行检测。结果术前患者血清FIB水平为(3.2±0.3)g/L,Ccr水平为(108.0±7.0)ml/min。阻断时,血清FIB升高至(3.5±0.5)g/L,Ccr下降至(94.0±8.0)ml/min,与术前比较差异有统计学意义(P<0.05)。解除阻断后1小时,FIB升高至(3.9±0.2)g/L,Ccr下降至(81.0±4.0)ml/min。解除阻断后2小时,FIB升高至(4.5±0.3)g/L,Ccr下降至(72.0±3.0)ml/min,较阻断前明显改变,差异有统计学意义(P<0.05)。解除阻断后6小时,FIB较阻断时下降(3.3±0.5)g/L,Ccr升高至(101.0±5.0)ml/min,较阻断后2小时明显不同并恢复至正常值,和阻断前相比差异无统计学意义(P>0.05)。结论腹主动脉下段球囊临时阻断术不可避免引起凝血功能异常及肾小球不同程度的缺血再灌注损伤,但损伤为一过性、可代偿的损害。Objective To investigate the changes and clinical significances of fibrinogen(FIB) and creatinine clearance rate(Ccr) during the temporary balloon occlusion of the lower abdominal aorta.Methods The clinical data of 58 patients with intractable pelvic surgery from May 2015 to December2016, including 11 cases of pelvic fracture, 22 cases of placenta previa complicated with placenta accreta,12 cases of sacral tumor resection, 13 cases of pelvic tumor resection were retrospectively analyzed. All the patients were given temporary balloon blocking-up of the lower abdominal aorta. The seum level of FIB and Ccr were detected preoperation, balloon blocking-up and postoperation. Results Before operation, serum FIB level was(3.2±0.3) g/L and Ccr level was(108.0±7.0) ml/min in all patients. During blocking, serum FIB increased to(3.5±0.5) g/L, and Ccr decreased to(94.0±8.0) ml/min compared with that before operation(P <0.05). FIB increased to(3.9 ±0.2) g/L and Ccr decreased to(81.0 ±4.0) ml/min at 1 hours after unblocking. After 2 hours of interruption, FIB increased to(4.5±0.3) g/L, and Ccr decreased to(72.0±3.0)ml/min, and the difference was statistically significant(P <0.05). After 6 hours of disconnection, FIB decreased(3.3±0.5) g/L, and Ccr increased to(101.0±5.0) ml/min, compared with 2 h after blocking, and recovered to normal value, the difference was statistically significant(P <0.05). Conclusion Temporary occlusion of the inferior segment of the abdominal aorta may cause coagulation dysfunction and ischemia-reperfusion injury of glomeruli to varying degrees, but this kind of injury was a transient and compensable damage.

关 键 词：腹主动脉 缺血 再灌注损伤 出血 纤维蛋白原 内生肌酐清除率 

分 类 号：R654.3[医药卫生—外科学]