自体血回输对心瓣膜置换手术患者血栓弹力图和纤溶指标的影响  

Effect of autologous blood transfusion on thrombelastogram and fibrinolysis indexes in patients undergoing cardiac valve replacement surgery

作　　者：范迪堃[1] 韩冬[1] 张壮[1] FAN Dikun;HAN Dong;ZHANG Zhuang(Department of Cardiothoracic Surgery,Nanyang Central Hospital,Nanyang Henan 473000,China)

机构地区：[1]南阳市中心医院心胸外科,河南南阳473000

出　　处：《临床与病理杂志》2020年第3期647-652,共6页Journal of Clinical and Pathological Research

摘　　要：目的:探讨体外循环(extracorporeal circulation,ECC)自体血回输对心脏瓣膜置换手术患者血栓弹力图(thrombelastogram,TEG)、纤溶指标的影响。方法:选取2016年7月至2017年12月在南阳市中心医院接受ECC自体血回输对心脏瓣膜置换手术患者63例,其中研究组30例患者采用自体血回输技术、对照组33例患者采用库存血输血;对比两组患者手术前后的血红蛋白(Hb)、红细胞压积(hematocrit,Hct)、血小板(platelet,PLT)、凝血酶原时间(prothrombin time,PT)、凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原降解产物(fibrinogen degradation product,FDP)、D-二聚体(D-D)、前列腺素E2(PGE2)、血小板α-颗粒膜蛋白(GM-140)及TEG参数的变化。结果:术前,两组患者的Hb,Hct测定值差异无统计学意义(P>0.05);术后24 h,研究组患者的Hb,Hct测定值显著高于对照组(P<0.05);术前,两组患者的PLT,PT,APTT,TT水平差异无统计学意义(P>0.05);术后24 h,研究组患者的PT,APTT测定值显著低于对照组(P<0.05);术前,两组患者的FDP,D-D,PGE2,GM-140测定值差异无统计学意义(P>0.05);术后24 h,研究组患者的FDP,D-D,PGE2,GM-140测定值显著低于对照组(P<0.05);术前,两组患者的R值、K值、MA值、α角差异无统计学意义(P>0.05);术后24 h,研究组患者的R值、K值显著低于对照组(P<0.05),研究组患者的MA值、α角显著高于对照组(P<0.05)。结论:ECC自体血回输对心脏瓣膜置换手术患者的凝血功能、TEG参数及纤溶系统稳定性影响更小。Objective:To investigate the effect of extra cardiac valve replacement surgery(ECC)on blood vessel thrombus(TEG)and fibrinolysis in patients undergoing cardiac valve replacement surgery.Methods:From July 2016 to December 2017,63 patients underwent ECC in our hospital,including 30 patients with autologous blood transfusion technique(the study group)and 33 patients with stored blood(the control group).Hemoglobin(Hb),hematocrit(Hct),platelet(PLT),prothrombin time(PT),thromboplastin time(APTT),thrombin time(TT),fibrinogen degradation product(FDP),D-dimer(D-D),prostaglandin E2(PGE2),platelet alpha-granule membrane protein(GM-140),and TEG parameters before and 24 h after surgery were compared between the two groups.Results:Before operation,the difference of Hb and Hct between the 2 groups was not statistically significant(P>0.05).At 24 hours after operation,the Hb and Hct values of the study group were significantly higher than those of the control group(P<0.05).Before operation,the differences of PLT,PT,APTT and TT levels between the two groups were not statistically significant(P>0.05).The PT and APTT values of the study group were significantly lower than those of the control group at 24 hours after operation(P<0.05).Before surgery,the difference of FDP,DD,PGE2 and GM-140 between the two groups were not statistically significant(P>0.05).The value was significantly lower than that of the control group(P<0.05).There was no significant difference in the R value,K value,MA value andαangle between the two groups before surgery(P>0.05).The R and K values were significantly lower than those in the control group(P<0.05)at 24 hours after operation.The MA value andαangle of the study group were significantly higher than those of the control group(P<0.05).Conclusion:ECC autologous blood transfusion has less effect on coagulation function,TEG parameters and stability of fibrinolytic system in patients undergoing cardiac valve replacement surgery.

关 键 词：体外循环 自体血回输 心脏瓣膜置换手术 血栓弹力图 纤溶指标 

分 类 号：R654.2[医药卫生—外科学]